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Mlyakado BP, Li JCM. Explaining the Help-Seeking Intentions of Adolescents Subject to Sexual Exploitation in Tanzania: An Application of the Theory of Planned Behavior. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16084-NP16106. [PMID: 34107823 DOI: 10.1177/08862605211023494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The sexual exploitation (SE) of children and adolescents is a universal concern. Numerous empirical studies have examined the prevalence and consequences of this phenomenon worldwide, but there is little information on the factors that determine the help-seeking intentions of adolescents subject to SE in Tanzania. We drew on the theory of planned behavior (TPB) to address this knowledge gap. The study had two main objectives. First, we examined four TPB variables (attitudes toward seeking help, perceived social support, perceived social stigma, and generalized self-efficacy) as determinants of the Tanzanian adolescents' help-seeking intentions. Second, we explored the moderating effects of social stigma on the relationship between the examined TPB factors and the adolescents' help-seeking intentions. A cross-sectional survey design was used to collect data from a stratified random sample of 1,116 secondary school adolescents aged 13-17 (M = 15.66; SD = 1.09). The participants were recruited from two regions in the east and northwest of Tanzania and data were analyzed using hierarchical multiple regression. The results indicate that the TPB variables of attitude toward seeking help, perceived social support, and generalized self-efficacy were positively associated with the help-seeking intentions of adolescents subject to SE, but not social stigma. Through moderation analyses, we found that social stigma significantly weakened the explanatory power of the attitude toward seeking help. The findings of this study in the context of Tanzania were discussed and implications for policy, practice, and future research were suggested.
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Mpeta KN, Moroke ND, Gabaitiri L. Explicating factors that explain condom use intention among in-school adolescents in Botswana: a structural equation modelling approach. SAHARA J 2021; 18:156-169. [PMID: 34789071 PMCID: PMC8604454 DOI: 10.1080/17290376.2021.2002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Knowledge with respect to adolescents' intentions to engage in protective sexual behaviours is still deficient in numerous countries around the world, particularly in Sub-Saharan Africa (SSA) where HIV prevalence is the highest. Increasing cross-sectional research suggests that the theory of planned behaviour (TPB) is robust in predicting condom use intentions. This study used secondary, baseline data from a study involving 794 in-school adolescents. A structural equation model was applied to the data. Latent variables were used to validate the applicability of the TPB in HIV/AIDS prevention among adolescents in the Botswana context. The predictors of interest were all derived from the TPB. The results revealed that the TPB predictors, apart from affective and instrumental attitude, were predictive of condom use intention among Batswana adolescents. The independent variables explained 57% of the variance in the model. These results suggest that the TPB is recommended as a framework to establish the predictors of condom use intention among Batswana in-school adolescents. Policy makers working on developing HIV education programmes or interventions targeted at adolescents should improve the intention to use condoms via promotion of positive instrumental attitudes, subjective norms and perceived behavioural control beliefs of condom use.
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Affiliation(s)
- Kolentino N. Mpeta
- Statistics and Operations Research Department, North West University, Mmabatho, South Africa
| | - Ntebogang D. Moroke
- Faculty of Economic and Management Sciences, North West University, Mmabatho, South Africa
| | - Lesego Gabaitiri
- Department of Mathematical and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana
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Almonte MT, Lynch CA. Impact of internal female migration on unmet need for modern contraception in Zambia. Reprod Health 2019; 16:169. [PMID: 31730493 PMCID: PMC6858709 DOI: 10.1186/s12978-019-0803-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background Unmet need for contraception, the proportion of women who want to limit or delay childbirth but use no form of contraception, is the core indicator to evaluate the effectiveness of family planning programs. Understanding how migration influences unmet need is important to identify to whom and how to target sexual and reproductive health programs. We assessed how migration status in rural and urban settings is associated with having an unmet need for family planning. Methods Data on sexually active, fecund, reproductive-aged (15–49 years) women from the 2013–14 Zambia Demographic and Health Survey were analysed through univariate and multivariate logistic regression models. Results Unmet need for modern contraceptive methods was significantly higher among rural to rural migrant women (OR 1.30, 95%CI 1.00–1.70 p < 0.05) and rural non-migrant women (OR 1.41, 95%CI 1.06–1.85 p < 0.01) compared to urban non-migrant women after controlling for age, marital status, parity, religion, education and wealth. Conclusion Women residing in, and migrating between, rural areas were significantly more likely to have an unmet need for contraception. Our findings highlight the importance of understanding migration and migrant streams to strengthen family planning programs. In Zambia, a focus on rural-rural migrants, rural non-migrants and the poorest could improve the health of the entire population.
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Affiliation(s)
- Melanie T Almonte
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline A Lynch
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
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Hosseini Hooshyar S, Karamouzian M, Mirzazadeh A, Haghdoost AA, Sharifi H, Shokoohi M. Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study. Int J Health Policy Manag 2018; 7:1007-1014. [PMID: 30624874 PMCID: PMC6326636 DOI: 10.15171/ijhpm.2018.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Given the young structure of Iran’s population and the fact that extramarital sexual relationships are both prohibited by legislation and shunned by society and religion, examining condom use practices among Iranian youth is highly important. The aim of this study was to explore condom use and its correlates among Iranian young adults.
Methods: In a sample of 3,045 individuals aged 19-29 who were recruited from a nation-wide study, we analyzed data from 633 participants who reported a history of extramarital sex. Subjects were asked about their condom use practices during their last penetrative sex. Data were collected through a self-administered questionnaire where the respondents completed the survey on their own and passed it to trained gender-matched interviewers. Multivariable regression models were constructed to report adjusted odds ratios (AOR) along with 95% CI.
Results: Of the 633 participants, 222 (35.1%) reported condom use at last sex. Men reported significantly higher condom use than women (38.5% vs. 25.7%). Having a stable job (AOR = 1.86, 95% CI: 1.01, 3.43), higher knowledge of condom use (AOR = 1.57, 95% CI: 1.03, 2.37) and sexual transmission of HIV (AOR = 1.83, 95% CI: 1.18, 2.85) were positively associated with condom use at last sex. Conversely, experience of sex under the influence of substances (AOR = 0.66, 95% CI: 0.45, 0.94) was significantly associated with reduced odds of condom use at last sex.
Conclusion: This study shows that only one out of every three young adults reported using condoms at last sex. While educational programs are helpful, multi-sectoral approaches (eg, individual-, community-, and structural-level interventions) are required to change sexual behaviours towards safe sex practices and reinforce negotiating condom use among youth.
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Affiliation(s)
- Samira Hosseini Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
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Lion R, Arulogun O, Titiloye M, Shaver D, Jain A, Godwin B, Sidibe M, Adejumo M, Rosseel Y, Schmidt P. The effect of the "Follow in my Green Food Steps" programme on cooking behaviours for improved iron intake: a quasi-experimental randomized community study. Int J Behav Nutr Phys Act 2018; 15:79. [PMID: 30115087 PMCID: PMC6097342 DOI: 10.1186/s12966-018-0710-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutritional iron deficiency is one of the leading factors for disease, disability and death. A quasi-experimental randomized community study in South-West Nigeria explored whether a branded behaviour change programme increased the use of green leafy vegetables (greens) and iron-fortified bouillon cubes in stews for improved iron intake. METHODS A coinflip assigned the intervention to Ile-Ife (Intervention town). Osogbo (Control town) received no information. At baseline 602 mother-daughter pairs (daughters aged 12-18) were enrolled (Intervention: 300; Control: 302). A Food Frequency Questionnaire assessed the addition of cubes and greens to stews, the primary outcome. Secondary outcomes were the addition of cubes and greens to soups and changes in behavioural determinants measured using the Theory of Planned Behaviour. Structural Equation Modelling (SEM) evaluated the impact of the intervention on behavioural determinants and behaviour. RESULTS The data of 527 pairs was used (Intervention: 240; Control: 287). The increase in greens added to stews was larger in the Intervention town compared to the Control town (MIntervention = 0.3 [SE = 0.03]; MControl = 0.0 [SE = 0.04], p < 0.001, r = 0.36). Change in iron-fortified cubes added to stews did not differ between towns (p = 0.07). The increase in cubes added to soups was larger in the Intervention town compared to the Control Town (MIntervention = 0.9 [SE = 0.2] vs MControl = 0.4 [SE = 0.1], p < .0001, r = 0.20). Unexpectedly, change in greens added to soups was larger in the Control town compared to the Intervention town (MIntervention = - 0.1 [SE = 0.1]; MControl = 0.5 [SE = 0.1], p = 0.003, r = 0.15). The intervention positively influenced awareness of anaemia and the determinants of behaviour in the Intervention town, with hardly any change in the Control town. Baseline SEMs could not be established, so no mediation analyses were done. Post-intervention SEMs highlighted the role of habit in cooking stews. CONCLUSIONS The behaviour change programme increased the amount of green leafy vegetables added to stews and iron-fortified cubes added to soups. Future research should assess the long-term impact and the efficacy of the programme as it is scaled up and rolled out.
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Affiliation(s)
- René Lion
- Unilever R&D Vlaardingen, Vlaardingen, The Netherlands.
| | - Oyedunni Arulogun
- Department of Health Promotion & Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Musibaau Titiloye
- Department of Health Promotion & Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Mumuni Adejumo
- Department of Environmental Health Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Yves Rosseel
- Department of Data Analysis, University of Ghent, Gent, Belgium
| | - Peter Schmidt
- University of Giessen & Humboldt Research Fellow at Cardinal Wyscinski University Warsaw, Warszawa, Poland
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Teye-Kwadjo E, Kagee A, Swart H. Does Past Condom Use Moderate the Future Condom Use Intention-Behavior Relationship? Results from a Ghanaian Sample. THE JOURNAL OF PSYCHOLOGY 2018; 152:325-340. [DOI: 10.1080/00223980.2018.1452710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Closson K, Dietrich JJ, Lachowsky NJ, Nkala B, Palmer A, Cui Z, Beksinska M, Smit JA, Hogg RS, Gray G, Miller CL, Kaida A. Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa. JOURNAL OF SEX RESEARCH 2018; 55:522-539. [PMID: 29466024 DOI: 10.1080/00224499.2017.1421607] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.
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Affiliation(s)
- Kalysha Closson
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Janan J Dietrich
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS
- d School of Public Health and Social Policy , University of Victoria
| | - Busiwe Nkala
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
- e Faculty of Humanities , University of the Witwatersrand
| | - Alexis Palmer
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Mags Beksinska
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Jennifer A Smit
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Robert S Hogg
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Glenda Gray
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Cari L Miller
- a Faculty of Health Sciences , Simon Fraser University
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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Abstract
The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5-12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8-12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.
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Affiliation(s)
- Maretha Visser
- PhD, is a professor in Psychology at the Department of Psychology, University of Pretoria, Pretoria, South Africa
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Teye-Kwadjo E, Kagee A, Swart H. Determinants of condom use among heterosexual young men and women in southeastern Ghana: a mediation analysis. PSYCHOLOGY & SEXUALITY 2017. [DOI: 10.1080/19419899.2017.1391870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Matieland, South Africa
| | - Hermann Swart
- Department of Psychology, Stellenbosch University, Matieland, South Africa
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Mmbaga EJ, Kajula L, Aarø LE, Kilonzo M, Wubs AG, Eggers SM, de Vries H, Kaaya S. Effect of the PREPARE intervention on sexual initiation and condom use among adolescents aged 12-14: a cluster randomised controlled trial in Dar es Salaam, Tanzania. BMC Public Health 2017; 17:322. [PMID: 28415973 PMCID: PMC5392916 DOI: 10.1186/s12889-017-4245-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Unsafe sexual practices continue to put adolescents at risk for a number of negative health outcomes in Tanzania. While there are some effective theory-based intervention packages with positive impact on important mediators of sexual behaviours, a context specific and tested intervention is urgently needed in Tanzania. Purpose To develop and evaluate an intervention that will have a significant effect in reducing sexual initiation and promoting condom use among adolescents aged 12–14 in Dar es Salaam, Tanzania. Design A school-based Cluster Randomised Controlled Trial was conducted during 2011–2014 in Kinondoni Municipality. Methods A total of 38 public primary schools were randomly selected, of which half were assigned to the intervention and half to the control group based on their size and geographic location. Participants were interviewed using a self-administered questionnaire at baseline before the PREPARE intervention and then, 6 and 12 months following intervention. The primary outcomes were self-reported sex initiation and condom use during the past 6 months. Data analysis was done using Generalized Estimating Equation (GEE) modelling controlling for repeated measures and clustering of students within schools. Results A total of 5091 students were recruited at baseline, and interviewed again at 6 (n = 4783) and 12 months (n = 4370). Mean age of participants at baseline was 12.4 years. Baseline sociodemographic, psychometric and behavioural characteristics did not significantly differ between the two study arms. The GEE analysis indicated that the intervention had a significant effect on sexual initiation in both sexes after controlling for clustering and correlated repeated measures. A significantly higher level of action planning to use condoms was reported among female adolescent in the intervention arm than those in the control arm (p = 0.042). An effect on condom use behaviour was observed among male adolescent (p = 0.004), but not among female (p = 0.463). Conclusions The PREPARE intervention had an effect in delaying self-reported sexual initiation among adolescents aged 12–14 in Dar es Salaam Tanzania. The intervention positively influenced action planning to use condoms for both sexes and increased actual condom use among male adolescents only. Future interventions addressing adolescent sexual and reproductive health should focus on impacting mediators of behaviour change. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000900718, registered on 13 August, 2013.
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Affiliation(s)
- Elia John Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania.
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Leif Edvard Aarø
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Mrema Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Annegreet Gera Wubs
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Sander Matthijs Eggers
- Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Manyaapelo T, Nyembezi A, Ruiter RAC, Borne BVD, Sifunda S, Reddy P. Understanding the Psychosocial Correlates of the Intention to Use Condoms among Young Men in KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E339. [PMID: 28333100 PMCID: PMC5409540 DOI: 10.3390/ijerph14040339] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/21/2023]
Abstract
South Africa leads the world with the number of people infected with HIV. Even with all attempts that have been made to curb HIV, it is still evident that new infections are on the rise. Condom use remains one of the best tools against this challenge yet a small number of sexually active men use them. This study investigates the psychosocial correlates of the intention to use condoms among young men in KwaZulu-Natal province. Using the Theory of Planned Behaviour as a framework, hierarchical linear regression models were used to determine the unique contribution of the study measures in explaining the overall variance of intention to consistently use condoms. Subjective norms and perceived behavioural control towards consistent condom use explained 46% of the variance in the intention to use a condom, suggesting that health behaviour interventions should focus on targeting the normative beliefs as well as control beliefs of the target population. Furthermore, subjective norms and intentions towards reducing alcohol and marijuana use explained an additional 7% to the final model in intentions to condom use, implying that substance use and condom usage may influence each other. No significant contributions were found for beliefs underlying cultural aspects of responsible manhood.
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Affiliation(s)
- Thabang Manyaapelo
- Human Sciences Research Council, Population Health, Health Systems and Innovation, Private Bag X41, Pretoria 0001, South Africa.
| | - Anam Nyembezi
- Human Sciences Research Council, Population Health, Health Systems and Innovation, Private Bag X9182, Cape Town 8000, South Africa.
| | - Robert A C Ruiter
- Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200 Maastricht, The Netherlands.
| | - Bart van den Borne
- Department of Health Education & Health Promotion, Maastricht University, P.O. Box 616, 6200 Maastricht, The Netherlands.
| | - Sibusiso Sifunda
- Human Sciences Research Council, HIV/AIDS, STIs and TB, Private Bag X41, Pretoria 0001, South Africa.
| | - Priscilla Reddy
- Human Sciences Research Council, Population Health, Health Systems and Innovation, Private Bag X9182, Cape Town 8000, South Africa.
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Teye-Kwadjo E, Kagee A, Swart H. Predicting the Intention to Use Condoms and Actual Condom Use Behaviour: A Three-Wave Longitudinal Study in Ghana. Appl Psychol Health Well Being 2017; 9:81-105. [PMID: 27925435 PMCID: PMC5659181 DOI: 10.1111/aphw.12082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Growing cross-sectional research shows that the theory of planned behaviour (TPB) is robust in predicting intentions to use condoms and condom use behaviour. Yet, little is known about the TPB's utility in explaining intentions to use condoms and condom use behaviour over time. METHODS This study used a longitudinal design and latent variable structural equation modelling to test the longitudinal relationships postulated by the TPB. School-going youths in Ghana provided data on attitudes, subjective norms, perceived control, intentions, and behaviour regarding condom use at three time points, spaced approximately three months apart. RESULTS As predicted by the TPB, the results showed that attitudes were significantly positively associated with intentions to use condoms over time. Contrary to the TPB, subjective norms were not significantly associated with intentions to use condoms over time. Perceived control did not predict intentions to use condoms over time. Moreover, intentions to use condoms were not significantly associated with self-reported condom use over time. CONCLUSION These results suggest that school-going youths in Ghana may benefit from sex education programmes that focus on within-subject attitude formation and activation. The theoretical and methodological implications of these results are discussed.
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Affiliation(s)
- Enoch Teye-Kwadjo
- Department of Psychology, University of Ghana, P. O. Box LG 84, Legon, Accra-Ghana. Telephone: (+233) 0544655650
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa. Telephone: (+27) 218083461
| | - Hermann Swart
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa. Telephone: (+27) 218089061
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Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana. Reprod Health 2016; 13:39. [PMID: 27080996 PMCID: PMC4832526 DOI: 10.1186/s12978-016-0161-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Adolescent pregnancy remains a public health concern, with diverse serious consequences, including increased health risk for mother and child, lost opportunities for personal development, social exclusion, and low socioeconomic attainments. Especially in Africa, teenage pregnancy rates are high. It is important to find out how girls without pregnancy experience differ in their contraceptive decision-making processes as compared with their previously studied peers with pregnancy experience to address the high rate of teenage pregnancies. Methods We conducted semi-structured in-depth interviews with never been pregnant girls (N = 20) in Bolgatanga, Ghana, to explore the psychosocial and environmental factors influencing the sexual decision making of adolescents. Themes such as relationships, sex, pregnancy, family planning and psychosocial determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behavior guided the development of the interview protocol. Results Results showed that the girls did talk about sexuality with their mothers at home and did receive some form of sexual and reproductive health education, including the use of condoms discussions in school. Participants reported high awareness of pregnancy risk related to unprotected sex, were positive about using condoms and indicated strong self-efficacy beliefs towards negotiating condom use. The girls also formulated clear future goals, including coping plans such as ways to prevent unwanted pregnancies to reach these targets. On the other hand, their attitudes towards family planning (i.e., contraceptives other than condoms) were negative, and they hold boys responsible for buying condoms. Conclusion An open parental communication on sexuality issues at home, comprehensive sex education in school and attitude, self-efficacy, risk perception towards contraception, alongside with goal-setting, seem to be protective factors in adolescent girls’ pregnancy prevention efforts. These factors should be targets in future intervention programs at the individual, interpersonal, and school and community levels.
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Eggers SM, Aarø LE, Bos AER, Mathews C, Kaaya SF, Onya H, de Vries H. Sociocognitive Predictors of Condom Use and Intentions Among Adolescents in Three Sub-Saharan Sites. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:353-65. [PMID: 25925898 PMCID: PMC4706577 DOI: 10.1007/s10508-015-0525-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/20/2014] [Accepted: 12/22/2014] [Indexed: 05/09/2023]
Abstract
Many HIV intervention programs in sub-Saharan Africa have applied social cognitive theories such as the theory of planned behavior. However, a recent sub-Saharan African review was unable to show increased effectiveness for theory-based interventions. This study assessed whether the predictive value of attitudes, subjective norms, self-efficacy, and intention was similar to studies in Europe and the U.S., and whether there were differences between three sub-Saharan sites. Longitudinal multigroup structural equation modeling was used to assess whether attitudes, subjective norms, and self-efficacy predicted condom use intentions and condom use (after 6 months) among adolescents in three sites, namely Cape Town (South Africa; N = 625), Dar es Salaam (Tanzania; N = 271), and Mankweng (South Africa; N = 404). Condom use intentions were predicted by subjective norms and self-efficacy in all three sites. Attitudes were not related to intentions in Dar es Salaam and were moderately related to intentions in Cape Town and Mankweng. The proportions of explained variance in intentions and behavior were decent (37-52 and 9-19%, respectively). Although significant differences in predictive value were found between sites and in comparison to European and U.S. studies, intentions could adequately be explained by attitudes, subjective norms, and self-efficacy. However, the limited proportions of variance in behavior explained by intentions could signify the importance of contextual and environmental factors. Future studies are recommended to use an integrative approach that takes into account both individual and contextual factors, as well as social and environmental differences.
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Affiliation(s)
- Sander M Eggers
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands.
| | - Leif E Aarø
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Arjan E R Bos
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Catherine Mathews
- Health System Research Unit, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sylvia F Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hans Onya
- Department of Public Health Practice and Health Promotion, School of Health Sciences, University of Limpopo-Turfloop Campus, Sovenga, South Africa
| | - Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
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Wubs AG, Aarø LE, Kaaya S, Onya H, Mathews C. Social Cognition Variables and Victimization as Predictors of Sexual Debut Among Adolescents in South Africa and Tanzania: A Multi-group SEM Analysis. AIDS Behav 2015; 19:2141-51. [PMID: 25957857 DOI: 10.1007/s10461-015-1087-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early sexual debut is common in South Africa and Tanzania, with potentially negative reproductive health outcomes. The role of violence as a predictor of sexual debut was studied, in a context of predictors borrowed from social cognition models. Data were taken from cluster-randomized trials of school-based HIV prevention interventions in three sites in South Africa and Tanzania. Analyses consisted of descriptive statistics and multi-group structural equation modelling. The basic model functioned fairly well for Cape Town, but less well for Mankweng and Dar es Salaam (low R(2) values). Attitudes were the strongest predictor of intention. Adding socio-demographic variables to the model did not reduce the associations much and neither did subsequent inclusion of violence. Sexual debut was strongly associated with victimization; adding violence also substantially increased R(2) for sexual debut. Besides social cognition factors, intimate partner violence should be addressed in future research on reproductive health interventions for adolescents.
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Affiliation(s)
- Annegreet Gera Wubs
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Postboks 7800, 5020, Bergen, Norway.
| | - Leif Edvard Aarø
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Postboks 7800, 5020, Bergen, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sylvia Kaaya
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hans Onya
- Health Promotion Unit, School of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Kalolo A, Kibusi SM. The influence of perceived behaviour control, attitude and empowerment on reported condom use and intention to use condoms among adolescents in rural Tanzania. Reprod Health 2015; 12:105. [PMID: 26563296 PMCID: PMC4643513 DOI: 10.1186/s12978-015-0097-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the declining trends of Human immunodeficiency virus (HIV) infection in Sub-Saharan Africa (SSA), unsafe sexual behaviours among adolescents still represent a public health challenge. It is important to understand factors acting at different levels to influence sexual behaviour among adolescents. This study examined the influence of perceived behaviour control, subjective norms, attitudes and empowerment on intention to use condoms and reported use of condoms among adolescents in rural Tanzania. METHODS We used a questionnaire to collect data from 403 adolescents aged 14 through 19 years from nine randomly selected secondary schools in the Newala district located in the Southern part of Tanzania. The self-administered questionnaire collected information on sexual practices and factors such as attitudes, subjective norms, perceived behaviour control and empowerment. Binary logistic regression was performed to identify factors associated with intention to use and reported use of condoms. RESULTS Sexually active adolescents constituted 40.6 % of the sample, among them 49.7 % did not use a condom at last sexual intercourse and 49.8 % had multiple sex partners. Many (85 %) of sexually active respondents had their sexual debut between the ages of 14 to 17 years. Girls became sexually active earlier than boys. Perceived behaviour control predicted intentions to use condoms (AOR = 3.059, 95 % CI 1.324-7.065), thus demonstrating its importance in the decision to use a condom. Empowerment (odds ratio = 3.694, 95 % CI 1.295-10.535) and a positive attitude (AOR = 3.484, 95 % CI 1.132-10.72) predicted reported condom use, thus turning the decision to actions. Subjective norms had only indirect effects on intention and reported use of condoms. CONCLUSION The findings suggest that unsafe sex practices are prevalent among school adolescents in rural areas of Tanzania. Perceived behaviour control and positive attitudes predict intensions to use condoms whereas empowerment predicts reported condom use. The findings may imply that safe sex promotion interventions that simultaneously address socio-cognitive and ecological determinants of sexual behaviours may improve adolescents' safe sex behaviours.
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Affiliation(s)
- Albino Kalolo
- Department of Community Health, St. Francis University college of Health and Allied Sciences, P.O.Box 175, Ifakara, Tanzania.
| | - Stephen Matthew Kibusi
- School of Nursing and Public Health, College of Health Sciences, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania.
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Mubyazi GM, Exavery A, Tenu F, Massaga JJ, Rugemalila J, Malebo HM, Wiketye V, Makundi EA, Ikingura JK, Mushi AK, Malekia SE, Mziray A, Ogondiek JW, Kahwa A, Kafuye MM, Malecela MN. Determinants of demand for condoms to prevent HIV infections among barmaids and guesthouse workers in two districts, Tanzania. BMC Res Notes 2015; 8:630. [PMID: 26526184 PMCID: PMC4630838 DOI: 10.1186/s13104-015-1621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Condoms are scientifically recommended as potential products for preventing infections attributable to human immuno-deficiency viruses (HIV). However, evidence on factors leading to their inadequate use in developing countries is still scanty. This paper reports an exploratory study of factors constraining condoms use in Tanzania from the perspectives of barmaids, guest-house workers and retailers. METHODS Data were collected in two districts-Mpwapwa in Dodoma Region and Mbeya Rural in Mbeya Region-between October and December 2011, using structured interviews with 238 individuals including barmaids, guesthouse workers and 145 retailers. Data analysis was performed using STATA 11 software. RESULTS Awareness about condoms was high among all study groups. Male condoms were more popular and available than female ones. A considerable proportion of the barmaids and guesthouses were disappointed with condoms being promoted and distributed to young children and disliked condom use during sexual intercourse. Accessibility of condoms was reported as being lowered by condom prices, shortage of information concerning their availability; short supply of condoms; some people shying away to be watched by children or adult people while purchasing condoms; retailers' using bad languages to condom customers; occasionally condom shops/kiosks found closed when they are urgently needed; and prevailing social perception of condoms to have low/no protective efficacy. Regression analysis of data from barmaids and guesthouse-workers indicated variations in the degree of condom acceptability and methods used to promote condoms among respondents with different demographic characteristics. CONCLUSION A combination of psychosocial and economic factors was found contributing to lower the demand for and actual use of condoms in study communities. Concerted measures for promoting condom use need to address the demand challenges and making operational research an integral element of monitoring and evaluation of the launched interventions, hence widening the evidence for informed policy decisions.
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Affiliation(s)
- Godfrey M Mubyazi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Amon Exavery
- Ifakara Health Institute (IHI), P.O Box 78373, Dar es Salaam, Tanzania.
| | - Filemoni Tenu
- Amani Medical Research Centre (MRC), P.O Box 81, Muheza, Tanzania.
| | - Julius J Massaga
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Jovitha Rugemalila
- National Bureau of Statistics (NBS), P.O Box 796, Dar es Salaam, Tanzania.
| | - Hamisi M Malebo
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Victor Wiketye
- NIMR Ngongongare Research Station, Usa River, P.O Box 514, Arusha, Tanzania.
| | - Emmanuel A Makundi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Joyce K Ikingura
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Adiel K Mushi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Sia E Malekia
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Abubakary Mziray
- Amani Medical Research Centre (MRC), P.O Box 81, Muheza, Tanzania.
| | - John W Ogondiek
- NIMR Ngongongare Research Station, Usa River, P.O Box 514, Arusha, Tanzania.
| | - Amos Kahwa
- Muhimbili Medical Research Centre, P.O Box 5004, Dar es Salaam, Tanzania.
| | - Mwanaidi M Kafuye
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Mwelecele N Malecela
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
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Devine-Wright H, Abraham C, Onya H, Ramatsea S, Themane M, Aarø LE. Correlates of condom use and condom-use motivation among young South Africans. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2015. [DOI: 10.1111/jasp.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Charles Abraham
- University of Exeter Medical School; University of Exeter; Exeter Devon
| | | | - Susan Ramatsea
- Health Promotion Unit, School of Public Health; University of Limpopo; Polokwane
| | | | - Leif Edvard Aarø
- Department of Health Promotion and Development, Faculty of Psychology; University of Bergen
- Division of Mental Health; Norwegian Institute of Public Health
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Protogerou C, Flisher AJ, Aarø LE, Mathews C. The theory of planned behaviour as a framework for predicting sexual risk behaviour in sub-Saharan African youth: A critical review. J Child Adolesc Ment Health 2015; 24:15-35. [PMID: 25865835 DOI: 10.2989/17280583.2011.621067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Amongst the psychological theories that have been used to help understand why people have unprotected sex, the Theory of Planned Behaviour (TPB: Ajzen 1991) has earned a prominent position. This article is a critical review of 11 peer-reviewed studies conducted in sub-Saharan Africa during 2001 to 2009, which used the TPB as a model of predicting sexual risk behaviour in young people. All the studies revealed the predictive ability of the TPB in urban, rural, and traditional African settings, with R (2) coefficients ranging between 0.14 and 0.67. With data comparing favourably to those obtained in the international literature, these studies indicate that the TPB can be used to study sexual risk intentions and behaviour in sub-Saharan African youth, and question arguments against the theory's use in non-Western settings.
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Affiliation(s)
- Cleo Protogerou
- a Department of Psychiatry and Mental Health, Division of Child and Adolescent Psychiatry , University of Cape Town , Rondebosch , 7700 , Cape Town , South Africa
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Scott-Sheldon LAJ, Walstrom P, Harrison A, Kalichman SC, Carey MP. Sexual risk reduction interventions for HIV prevention among South African youth: a meta-analytic review. Curr HIV Res 2014; 11:549-58. [PMID: 24476351 DOI: 10.2174/1570162x12666140129105726] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 10/23/2013] [Accepted: 12/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine the efficacy of sexual risk reduction interventions among South African youth. METHODS Electronic databases were searched to identify studies published between 2007 and early 2013. Studies were eligible if they (1) targeted youth age 9-26, (2) evaluated sexual risk reduction interventions and (3) reported at least one behavioral outcome. Independent raters coded study characteristics, and intervention content. Weighted mean effect sizes were calculated; positive effect sizes indicated less sexual risk behavior and incident STIs. RESULTS Ten studies (k = 11; N = 22,788; 54% female; 79% Black-African) were included. Compared to controls, interventions were successful at delaying sexual intercourse and, among sexually active youth, at increasing condom use. A single study found reductions in the incidence of herpes simplex virus-2, but not HIV. CONCLUSIONS Implementing behavioral interventions to delay sexual debut and improve condom use can help to reduce the transmission of HIV among South African youth.
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Affiliation(s)
| | | | | | | | - Michael P Carey
- The Miriam Hospital, Centers for Behavioral and Preventive Medicine, CORO West, Suite 309, 164 Summit Ave., Providence, RI 02906, USA.
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Protogerou C, Johnson BT. Factors underlying the success of behavioral HIV-prevention interventions for adolescents: a meta-review. AIDS Behav 2014; 18:1847-63. [PMID: 24903669 DOI: 10.1007/s10461-014-0807-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this meta-review was to identify characteristics of successful HIV prevention interventions for adolescents based on quantitative (i.e., meta-analyses) and qualitative reviews published to date, and to inform intervention utilization and future development. To that end, we were guided by principles of triangulation. Searches of seven electronic bibliographic databases yielded five meta-analyses and six qualitative reviews that satisfied the selection criteria. Reviews were subjected to careful content analysis. All reviews reported that behavioral interventions had positive outcomes on at least one of the following outcomes: HIV-related knowledge, subjective cognitions and beliefs enabling safer sex, abstinence, delaying next sexual intercourse, decreasing number of sexual partners, and actual condom use. Four categories, suggesting factors more prominently linked to intervention success, emerged: behavior change techniques (e.g., cognitive-behavior and motivation enhancement skills training); recipient characteristics (e.g., age, vulnerability to contracting STIs/HIV); prominent design features (e.g., use of theory, formative research); and socio-ecological features (e.g., supportive school environment). Future interventions would benefit from conducting preliminary formative research in order to enable optimal implementation of all these factors.
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Affiliation(s)
- Cleo Protogerou
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA,
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De Vries H, Eggers SM, Jinabhai C, Meyer-Weitz A, Sathiparsad R, Taylor M. Adolescents' beliefs about forced sex in KwaZulu-Natal, South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1087-95. [PMID: 24729133 PMCID: PMC4133072 DOI: 10.1007/s10508-014-0280-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 11/09/2013] [Accepted: 01/02/2014] [Indexed: 05/23/2023]
Abstract
Gender-based violence has serious consequences for the psychological, physical, and sexual well-being of both men and women. Various gender roles, attitudes, and practices in South Africa create an environment that fosters submission and silence in females and hegemony and coercion in males. One of the expressions of this power inequity is a high prevalence of forced sex, which in its turn is associated with higher risk of HIV infection. This study therefore assessed potential gender differences in beliefs about forced sex and in prevalence of reported forced sex among high school students (N = 764) in KwaZulu-Natal. Results showed that significantly more boys were sexually active (26 %) than girls (12 %) and that boys experienced earlier sexual debut by over a year. Boys also held a more positive view about forced sex than girls since they associated it more often with signs of love, as an appropriate way to satisfy sexual urges, and as acceptable if the girl was financially dependent on the boy. The perception that peers and friends considered forced sex to be an effective way to punish a female partner was also more common among boys. On the other hand, boys were less knowledgeable about the health and legal consequences of forced sex, but no significant differences were found for other sociocognitive items, such as self-efficacy and behavioral intention items. Consequently, health education programs are needed to inform both boys and girls about the risks of forced sex, to convince boys and their friends about its inappropriateness and girls to empower themselves to avoid forced sex.
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Affiliation(s)
- Hein De Vries
- Department of Health Education and Health Promotion, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands,
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Nyembezi A, Ruiter RAC, van den Borne B, Sifunda S, Funani I, Reddy P. Correlates of consistent condom use among recently initiated and traditionally circumcised men in the rural areas of the Eastern Cape Province, South Africa. BMC Public Health 2014; 14:668. [PMID: 24975721 PMCID: PMC4083871 DOI: 10.1186/1471-2458-14-668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 06/25/2014] [Indexed: 11/20/2022] Open
Abstract
Background Consistent use of condoms is the most effective method of preventing STIs including HIV. However, recent evidence suggests that limited knowledge about HIV prevention benefits from male circumcision leads to inconsistent condom use among traditionally circumcised men. The aim of this paper is to report on the prevalence of consistent condom use and identify its psychosocial correlates to inform future HIV prevention strategies among traditionally circumcised men in rural areas of the Eastern Cape Province of South Africa. Methods A cross-sectional study using interviewer administered fully structured questionnaires was conducted among 1656 men who had undergone initiation and traditional male circumcision in rural areas of the Eastern Cape Province of South Africa. Logistic regression was used to evaluate univariate and multivariate relationships of psychosocial correlates with consistent condom use. Results The mean age of the participants was 21.4 years. About 45% belonged to the amaXhosa ethnic group, followed by 15.1% of the amaMpondo, 11.6% of the amaHlubi, and 27.9% from other ethnic groups. A total of 72.3% reported having a main sexual partner and of those 44.8% indicated having other sexual partners as well. About 49% reported consistent condom use and 80% used free government issued condoms, varies among ethnic groups. A total of 35.1% indicated having tested for HIV. Of those who tested for HIV, 46% reported inconsistent condom use when having sex with their sexual partners. Univariate and multivariate analyses showed a positive association between consistent condom use and the general knowledge of condom use, attitude towards condom use with main and casual sexual partners, subjective norm towards condom use with the main sexual partner, perceived self-efficacy towards condom use, positive self-esteem, beliefs about traditional male circumcision and STI protection, attitude towards gender based violence, and cultural alienation. Conclusions The study findings reveal important target points for future cultural sensitive health education aimed at increasing consistent condom use among initiated and traditionally circumcised men in the Eastern Cape Province.
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Affiliation(s)
- Anam Nyembezi
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Private Bag X9182, Cape Town 8000, South Africa.
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Mehra D, Östergren PO, Ekman B, Agardh A. Inconsistent condom use among Ugandan university students from a gender perspective: a cross-sectional study. Glob Health Action 2014; 7:22942. [PMID: 24725363 PMCID: PMC3984407 DOI: 10.3402/gha.v7.22942] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/22/2022] Open
Abstract
Background Feminization of the HIV/AIDS epidemic has been a prominent phenomenon in sub-Saharan Africa. Inconsistent condom use among young people is one of the major risk factors in the continued propagation of the epidemic. Therefore, it is of importance to increase knowledge of gender aspects of condom use among young people. Objective To investigate whether gender differences regarding individual and social factors determine the association between condom efficacy and inconsistent condom use with a new sex partner, among Ugandan university students. Design In 2010, 1954 Ugandan students participated in a cross-sectional survey, conducted at Mbarara University of Science and Technology in southwestern Uganda. A self-administered questionnaire assessed socio-demographic factors, alcohol consumption, sexual behaviors (including condom use and condom efficacy), and peer norms. The data were stratified by sex and examined by multivariate logistic regression analysis. Results A total of 1,179 (60.3%) students reported having had their sexual debut. Of these, 231 (37.4%) males and 209 (49.2%) females reported inconsistent condom use with a new sex partner. Students with low condom efficacy had a higher risk of inconsistent condom use with a new sex partner, even after adjusting for the potential confounders. A synergistic effect was observed between being a female and low condom efficacy with inconsistent condom use. Conclusion The association between inconsistent condom use and low condom efficacy was found among both males and females, but females were found to be at a higher risk of inconsistent condom use compared to their male counterparts. Therefore, gender power relations should be addressed in policies and interventions aiming at increasing condom use among young people in sub-Saharan settings. Programs could be designed with intervention strategies that focus on interactive and participatory educational activities and youth-friendly counseling of young people, which in turn may improve their interpersonal communication and condom negotiation skills with their partners.
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Affiliation(s)
- Devika Mehra
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden;
| | - Per-Olof Östergren
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Björn Ekman
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Valadez JJ, Jeffery C, Davis R, Ouma J, Lwanga SK, Moxon S. Putting the C back into the ABCs: a multi-year, multi-region investigation of condom use by Ugandan youths 2003-2010. PLoS One 2014; 9:e93083. [PMID: 24705381 PMCID: PMC3976401 DOI: 10.1371/journal.pone.0093083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/03/2014] [Indexed: 11/28/2022] Open
Abstract
A major strategy for preventing transmission of HIV and other STIs is the consistent use of condoms during sexual intercourse. Condom use among youths is particularly important to reduce the number of new cases and the national prevalence. Condom use has been often promoted by the Uganda National AIDS Commission. Although a number of studies have established an association between condom use at one’s sexual debut and future condom use, few studies have explored this association over time, and whether the results are generalizable across multiple locations. This multi time point, multi district study assesses the relationship between sexual debut and condom use and consistent use of condoms thereafter. Uganda has used Lot Quality Assurance Sampling surveys since 2003 to monitor district level HIV programs and improve access to HIV health services. This study includes 4518 sexually active youths interviewed at five time points (2003–2010) in up to 23 districts located across Uganda. Using logistic regression, we measured the association of condom use at first sexual intercourse on recent condom usage, controlling for several factors including: age, sex, education, marital status, age at first intercourse, geographical location, and survey year. The odds of condom use at last intercourse, using a condom at last intercourse with a non-regular partner, and consistently using a condom are, respectively, 9.63 (95%WaldCI = 8.03–11.56), 3.48 (95%WaldCI = 2.27–5.33), and 11.12 (95%WaldCI = 8.95–13.81) times more likely for those individuals using condoms during their sexual debut. These values did not decrease by more than 20% when controlling for potential confounders. The results suggest that HIV prevention programs should encourage condom use among youth during sexual debut. Success with this outcome may have a lasting influence on preventing HIV and other STIs later in life.
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Affiliation(s)
- Joseph J. Valadez
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Caroline Jeffery
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
- * E-mail:
| | - Rosemary Davis
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Joseph Ouma
- Management Sciences for Health, Kampala, Uganda
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Stephen K. Lwanga
- Management Sciences for Health, Kampala, Uganda
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
| | - Sarah Moxon
- Liverpool School of Tropical Medicine, Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool, United Kingdom
- Strengthening TB and AIDS Response in the Eastern Region - Lot Quality Assurance Sampling (STAR E-LQAS) Project, Kampala, Uganda
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Aarø LE, Mathews C, Kaaya S, Katahoire AR, Onya H, Abraham C, Klepp KI, Wubs A, Eggers SM, de Vries H. Promoting sexual and reproductive health among adolescents in southern and eastern Africa (PREPARE): project design and conceptual framework. BMC Public Health 2014; 14:54. [PMID: 24438582 PMCID: PMC3908968 DOI: 10.1186/1471-2458-14-54] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/14/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Young people in sub-Saharan Africa are affected by the HIV pandemic to a greater extent than young people elsewhere and effective HIV-preventive intervention programmes are urgently needed. The present article presents the rationale behind an EU-funded research project (PREPARE) examining effects of community-based (school delivered) interventions conducted in four sites in sub-Saharan Africa. One intervention focuses on changing beliefs and cognitions related to sexual practices (Mankweng, Limpopo, South Africa). Another promotes improved parent-offspring communication on sexuality (Kampala, Uganda). Two further interventions are more comprehensive aiming to promote healthy sexual practices. One of these (Western Cape, South Africa) also aims to reduce intimate partner violence while the other (Dar es Salaam, Tanzania) utilises school-based peer education. METHODS/DESIGN A modified Intervention Mapping approach is used to develop all programmes. Cluster randomised controlled trials of programmes delivered to school students aged 12-14 will be conducted in each study site. Schools will be randomly allocated (after matching or stratification) to intervention and delayed intervention arms. Baseline surveys at each site are followed by interventions and then by one (Kampala and Limpopo) or two (Western Cape and Dar es Salaam) post-intervention data collections. Questionnaires include questions common for all sites and are partly based on a set of social cognition models previously applied to the study of HIV-preventive behaviours. Data from all sites will be merged in order to compare prevalence and associations across sites on core variables. Power is set to .80 or higher and significance level to .05 or lower in order to detect intervention effects. Intraclass correlations will be estimated from previous surveys carried out at each site. DISCUSSION We expect PREPARE interventions to have an impact on hypothesized determinants of risky sexual behaviour and in Western Cape and Dar es Salaam to change sexual practices. Results from PREPARE will (i) identify modifiable cognitions and social processes related to risky sexual behaviour and (ii) identify promising intervention approaches among young adolescents in sub-Saharan cultures and contexts. TRIAL REGISTRATIONS Controlled Trials ISRCTN56270821 (Cape Town); Controlled Trials ISRCTN10386599 (Limpopo); Clinical Trials NCT01772628 (Kampala); Australian New Zealand Clinical Trials Registry ACTRN12613000900718 (Dar es Salaam).
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Affiliation(s)
- Leif Edvard Aarø
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Catherine Mathews
- Health Systems Research Unit, Medical Research Council, Cape Town, South Africa
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anne Ruhweza Katahoire
- Child Health and Development Centre, College of Health of Science, Makerere University, Kampala, Uganda
| | - Hans Onya
- Department of Public Health Practice and Health Promotion, School of Health Sciences, University of Limpopo, Turfloop Campus, Sovenga, South Africa
| | | | - Knut-Inge Klepp
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Annegreet Wubs
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Sander Matthijs Eggers
- Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
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Kiene SM, Hopwood S, Lule H, Wanyenze RK. An empirical test of the Theory of Planned Behaviour applied to contraceptive use in rural Uganda. J Health Psychol 2013; 19:1564-75. [PMID: 23928989 DOI: 10.1177/1359105313495906] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a high unmet need for contraceptives in developing countries such as Uganda, with high population growth, where efforts are needed to promote family planning and contraceptive use. Despite this high need, little research has investigated applications of health-behaviour-change theories to contraceptive use among this population. This study tested the Theory of Planned Behaviour's ability to predict contraceptive-use-related behaviours among post-partum women in rural Uganda. Results gave modest support to the theory's application and suggest an urgent need for improved theory-based interventions to promote contraceptive use in the populations of developing countries.
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Affiliation(s)
- Susan M Kiene
- University of Connecticut School of Medicine, USA Brown University, USA Rhode Island Hospital, USA
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Protogerou C, Flisher AJ, Wild LG, Aarø LE. Predictors of condom use in South African university students: a prospective application of the theory of planned behavior. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2013. [DOI: 10.1111/jasp.12039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cleo Protogerou
- Department of Psychiatry and Mental Health, Division of Child and Adolescent Psychiatry; University of Cape Town; Cape Town South Africa
| | - Alan J. Flisher
- Department of Psychiatry and Mental Health, Division of Child and Adolescent Psychiatry; University of Cape Town; Cape Town South Africa
| | | | - Leif E. Aarø
- Norwegian Institute of Public Health; Division of Mental Health; Oslo Norway
- University of Bergen; Department of Health Promotion and Development; Bergen Norway
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Shaweno D, Tekletsadik E. Validation of the condom use self-efficacy scale in Ethiopia. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:22. [PMID: 23617404 PMCID: PMC3644237 DOI: 10.1186/1472-698x-13-22] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
Background The measurement of condom use self-efficacy requires contextually suitable, valid and reliable instruments due to variability of the scale across nations with different cultural and ethnic backgrounds. This study aims to construct a condom use self-efficacy scale suitable to Ethiopia (CUSES-E), based on the original scale developed by Brafford and Beck. Methods A cross-sectional study was conducted on a random sample of 492 students at Hawassa University. A self-administered questionnaire containing 28 items from the original scale was used to collect the data. Principal Component Analysis (PCA) with Varimax rotation was used to extract factor structures. Cronbach’s alpha and item-total correlations were used to determine the internal consistency of the scale. The convergent and discriminant validity of the scale was verified using a correlation matrix. Results The PCA extracted three factors containing a total of 9-items. The extracted factors were labeled Assertiveness, Fear for partner rejection and Intoxicant Control, with internal consistency coefficients (Cronbach’s alpha) of 0.86, 0.86 and 0.92, respectively. Altogether, the factors explained 77.8% of variance in the items. An evaluation of CUSES-E showed a significantly higher self-efficacy score among students who ever used condoms; P < 0.001. The correlation matrix revealed that all of the convergent correlations were higher than the discriminant ones, providing evidence in support of both types of validity. In the split sample validation, the communalities, factor loadings and factor structure were the same on the analysis on each half and the full data set, suggesting that the new scale is generalizable and replicable. Conclusion This study of CUSES using an Ethiopian population found a different dimension to emerge, suggesting that the scale should be validated to local contexts before application. The CUSES-E is valid, reliable and replicable. Therefore, health cadres and researchers in Ethiopia can apply this scale to promote condom utilization to Ethiopian school youths. However, future research to develop a suitable scale (highly valid and reliable) in concordance with the local vernacular using a prior qualitative study is needed.
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Affiliation(s)
- Debebe Shaweno
- Epidemiology and Biostatistics Unit, School of Public and Environmental Health, Hawassa University, P.O. Box 1560, Hawassa, Ethiopia.
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Development and psychometric testing of the Antenatal Care Scale within the context of the Theory of Planned Behaviour. Midwifery 2013; 29:1035-40. [PMID: 23337692 DOI: 10.1016/j.midw.2012.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/22/2012] [Accepted: 09/29/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop an instrument based on the Theory of Planned Behaviour (TPB) to determine the attitudes and intentions of women towards receiving antenatal care. DESIGN This methodological study was carried out at health centres in Isparta, Turkey. METHODS 266 pregnant women who were able to communicate, did not have a systemic disease, and who volunteered to participate were included in this study. They were chosen by a random sampling method. A Likert-type scale composed of six subfactors and 26 items was used. RESULTS Cronbach's α for the Antenatal Care Scale (ANCS) was 0.96, and values for the six subfactors were between 0.88 and 0.94. CONCLUSIONS The ANCS was found to be a valid and reliable instrument to determine the attitudes and intentions of women towards receiving antenatal care.
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Rijsdijk LE, Bos AER, Lie R, Ruiter RAC, Leerlooijer JN, Kok G. Correlates of delayed sexual intercourse and condom use among adolescents in Uganda: a cross-sectional study. BMC Public Health 2012; 12:817. [PMID: 22998762 PMCID: PMC3503743 DOI: 10.1186/1471-2458-12-817] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 09/12/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Comprehensive sex education, including the promotion of consistent condom use, is still an important intervention strategy in tackling unplanned pregnancies, HIV/AIDS and sexually transmitted infections (STIs) among Ugandan adolescents. This study examines predictors of the intention to use a condom and the intention to delay sexual intercourse among secondary school students (aged 12-20) in Uganda. METHODS A school-based sample was drawn from 48 secondary schools throughout Uganda. Participants (N = 1978) completed a survey in English measuring beliefs regarding pregnancy, STIs and HIV and AIDS, attitudes, social norms and self-efficacy towards condom use and abstinence/delay, intention to use a condom and intention to delay sexual intercourse. As secondary sexual abstinence is one of the recommended ways for preventing HIV, STIs and unplanned pregnancies among the sexually experienced, participants with and without previous sexual experience were compared. RESULTS For adolescents without sexual experience (virgins), self-efficacy, perceived social norms and attitude towards condom use predicted the intention to use condoms. Among those with sexual experience (non-virgins), only perceived social norm was a significant predictor. The intention to delay sexual intercourse was, however, predicted similarly for both groups, with attitudes, perceived social norm and self-efficacy being significant predictors. CONCLUSIONS This study has established relevant predictors of intentions of safe sex among young Ugandans and has shown that the intention to use condoms is motivated by different factors depending on previous sexual experience. A segmented approach to intervention development and implementation is thus recommended.
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Affiliation(s)
- Liesbeth E Rijsdijk
- Windesheim University of Applied Sciences, Windesheim Honours College, Zwolle, the Netherlands
| | | | - Rico Lie
- Wageningen University, Wageningen, the Netherlands
| | | | | | - Gerjo Kok
- Maastricht University, Maastricht, the Netherlands
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Chamratrithirong A, Kaiser P. The dynamics of condom use with regular and casual partners: analysis of the 2006 National Sexual Behavior Survey of Thailand. PLoS One 2012; 7:e42009. [PMID: 22860047 PMCID: PMC3408404 DOI: 10.1371/journal.pone.0042009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aims to determine factors associated with levels of condom use among heterosexual Thai males in sex with regular partners and in sex with casual partners. METHODS The data used in this study are from the national probability sample of the 2006 National Sexual Behavior Study, the third nationally representative cross-sectional survey in Thailand. A subtotal of 2,281 men were analyzed in the study, including young (18-24) and older (25-59) adults who were residents of rural areas of Thailand, non-Bangkok urban areas, and Bangkok. Two outcomes of interest for this analysis are reported condom use in the past 12 months by males in relationships with the most recent regular and casual partners who were not sex workers. Chi-square statistics, bivariate regressions and the proportional odds regression models are used in the analysis. RESULTS Condom use for men with their regular partner is revealed to be positively related to education, knowledge of condom effectiveness, and pro-condom strategy, and negatively related to non-professional employment, status of registered marriage, and short relationship duration. Condom use with casual partner is positively determined by education, condom knowledge, non-professional occupation, short relationship duration, and lack of history of paid sex. CONCLUSION The national survey emphasized the importance of risk perceptions and condom motivations variables in explaining condom use among men in Thailand. These factors include not only education and knowledge of condom effectiveness and pro-condom strategy but also types of partners and their relationship context and characteristics. Program intervention to promote condom use in Thailand in this new era of predominant casual sex rather than sex with sex workers has to take into account more dynamic partner-based strategies than in the past history of the epidemics in Thailand.
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Affiliation(s)
- Aphichat Chamratrithirong
- Institute for Population and Social Research, Mahidol University, Phutthamonthon, Nakhon Pathom,Thailand.
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Condoms "contain worms" and "cause HIV" in Tanzania: Negative Condom Beliefs Scale development and implications for HIV prevention. Soc Sci Med 2012; 75:1685-91. [PMID: 22877934 DOI: 10.1016/j.socscimed.2012.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/30/2012] [Accepted: 07/09/2012] [Indexed: 11/21/2022]
Abstract
Condom promotion remains a key component of HIV prevention programs, complimenting recent successes in biomedical HIV prevention. Although condom use has increased in much of East Africa, it remains substantially below optimal levels. Negative rumors about condoms have been documented in East Africa, yet the prevalence and effects of belief in the negative rumors have not been explored. This study evaluated levels of belief in negative rumors about condoms, developed a Negative Condom Beliefs Scale, and assessed its accuracy in predicting willingness to use condoms. A cross-sectional, cluster survey (n = 370) was conducted representing adults in two rural districts in Northern Tanzania in 2008. Item agreement ranged from 35 to 53% for the following rumors regarding condoms: causing cancer, having holes, containing HIV, having worms, and the worms causing HIV. Items loaded on a single latent factor and had high internal consistency and convergent validity. In a multivariate model, negative condom score (AOR = 0.67, 95% CI = 0.6, 0.8) was the strongest single predictor of willingness to use condoms, followed by greater perceived anonymity in acquiring condoms (AOR = 4.36, 95% CI = 2.2, 8.6) and higher condom self-efficacy (AOR = 4.24, 95% CI = 2.0, 8.9). Our findings indicate high levels of subscription to negative beliefs about condoms, with two out of three respondents affirming belief in at least one negative condom rumor. This study highlights the relation between condom rumor beliefs and willingness to use condoms, and indicates avenues for future research and means for improving the design of HIV prevention programs.
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Maticka-Tyndale E. Condoms in sub-Saharan Africa. Sex Health 2012; 9:59-72. [DOI: 10.1071/sh11033] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 11/16/2011] [Indexed: 11/23/2022]
Abstract
Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.
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Lau CY, Swann EM, Singh S, Kafaar Z, Meissner HI, Stansbury JP. Conceptual framework for behavioral and social science in HIV vaccine clinical research. Vaccine 2011; 29:7794-800. [PMID: 21821083 PMCID: PMC3190058 DOI: 10.1016/j.vaccine.2011.07.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 07/01/2011] [Accepted: 07/24/2011] [Indexed: 11/18/2022]
Abstract
HIV vaccine clinical research occurs within a context where biomedical science and social issues are interlinked. Previous HIV vaccine research has considered behavioral and social issues, but often treated them as independent of clinical research processes. Systematic attention to the intersection of behavioral and social issues within a defined clinical research framework is needed to address gaps, such as those related to participation in trials, completion of trials, and the overall research experience. Rigorous attention to these issues at project inception can inform trial design and conduct by matching research approaches to the context in which trials are to be conducted. Conducting behavioral and social sciences research concurrent with vaccine clinical research is important because it can help identify potential barriers to trial implementation, as well as ultimate acceptance and dissemination of trial results. We therefore propose a conceptual framework for behavioral and social science in HIV vaccine clinical research and use examples from the behavioral and social science literature to demonstrate how the model can facilitate identification of significant areas meriting additional exploration. Standardized use of the conceptual framework could improve HIV vaccine clinical research efficiency and relevance.
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Affiliation(s)
- Chuen-Yen Lau
- Medical Officer, Collaborative Clinical Research Branch, Division of Clinical Research, NIAID, NIH, 6700B Rockledge Drive, Rm. 1112, Bethesda, MD. 20892, (301) 496-3947 (office), (301) 435-6739 (fax),
| | - Edith M. Swann
- Medical Officer/Nurse Consultant, Vaccine Clinical Research Branch, VRP/DAIDS/NIAID/NIH/DHHS, 6700B Rockledge Drive, Rm. 5256, Bethesda, MD. 20892, 301-451-2780 (office), 301-402-3684 (fax),
| | - Sagri Singh
- Senior Director - Country & Regional Programmes, International AIDS Vaccine Initiative, 110 Williams Street, 27th Floor, New York, NY 10038-3901, +1-212-328-7480 (office), +1-212-847-1112 (fax),
| | - Zuhayr Kafaar
- Department of Psychology, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa, +27 21 808 3447,
| | - Helen I. Meissner
- Senior Advisor, Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, 31 Center Drive, Building 31/Room B1C19, Bethesda, MD 20892-2027, (301) 594-2105,
| | - James P. Stansbury
- Previous Fellow at NIH/OBSSR, now at FDA/CDER/OND/SEALD, WO Bldg. 22, Room 2433, 10903 New Hampshire Avenue, Silver Spring, MD 20993, (301) 796-7552,
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Aarø LE, Breivik K, Klepp KI, Kaaya S, Onya HE, Wubs A, Helleve A, Flisher AJ. An HIV/AIDS knowledge scale for adolescents: item response theory analyses based on data from a study in South Africa and Tanzania. HEALTH EDUCATION RESEARCH 2011; 26:212-224. [PMID: 21257677 DOI: 10.1093/her/cyq086] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 14-item human immunodeficiency virus/acquired immunodeficiency syndrome knowledge scale was used among school students in 80 schools in 3 sites in Sub-Saharan Africa (Cape Town and Mankweng, South Africa, and Dar es Salaam, Tanzania). For each item, an incorrect or don't know response was coded as 0 and correct response as 1. Exploratory factor analyses based on polychoric correlations showed two separate factors for all sites. Two-parameter item response theory (IRT) analysis (bifactorial multiple indicators multiple causes confirmatory factor analysis models) consistently showed a general first factor and a second 'method' factor. One single global latent variable seemed to sufficiently well capture most of the systematic variation in knowledge. Some items did not discriminate well between levels of the underlying knowledge latent variable and information values were highest for low levels of knowledge. The scale might be improved by adding items, in particular items that are more difficult to answer. Some differential item functioning effects related to site and socioeconomic status were identified. Scores on the latent knowledge variable were particularly low among females in Dar es Salaam and Mankweng, and were negatively associated with socioeconomic status. This study illustrates advantages of using IRT analysis instead of more conventional approaches to examining psychometric properties of knowledge scales.
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Affiliation(s)
- Leif E Aarø
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway.
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Enah C, Sommers M, Moneyham L, Ann Long C, Childs G. Piloting an HIV Prevention Intervention for Cameroonian Girls. J Assoc Nurses AIDS Care 2010; 21:512-21. [DOI: 10.1016/j.jana.2010.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 02/25/2010] [Indexed: 10/19/2022]
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Asante KO, Doku PN. Cultural adaptation of the condom use self efficacy scale (CUSES) in Ghana. BMC Public Health 2010; 10:227. [PMID: 20433724 PMCID: PMC2874779 DOI: 10.1186/1471-2458-10-227] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 04/30/2010] [Indexed: 11/10/2022] Open
Abstract
Background Accurate assessment of self-reports of sexual behaviours is vital to the evaluation of HIV prevention and family planning interventions. This investigation was to determine the cross-cultural suitability of the Condom Use Self Efficacy Scale (CUSES) originally developed for American adolescents and young adults by examining the structure and psychometric properties. Method A self-administered cross-sectional survey of a convenient sample of 511 participants from a private university in Ghana with mean age 21.59 years. Result A Principal Component Analysis with varimax rotation identified a 14 item scale with four reliable factors labelled Appropriation (Cronbach alpha = .85), Assertive (Cronbach alpha = .90), Pleasure and Intoxicant (Cronbach alpha = .83), and STDs (Cronbach alpha = .81) that altogether explained 73.72% of the total variance. The scale correlated well with a measure of condom use at past sexual encounter (r = .73), indicating evidence of construct and discriminatory validity. The factor loadings were similar to the original CUSES scale but not identical suggesting relevant cultural variations. Conclusion The 14 item scale (CUSES-G) is a reliable and valid instrument for assessing condom use self efficacy. It is culturally appropriate for use among Ghanaian youth to gauge actual condom use and to evaluate interventions meant to increase condom use. Finally, the study cautioned researchers against the use of the original CUSES without validation in African settings and contexts.
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Affiliation(s)
- Kwaku O Asante
- Regent University College of Science and Technology, Department of Human Development and Psychology, City Campus, Dansoman, Ghana
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