The use of the Multidimensional Condom Attitude Scale in Chinese young adults

Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study

BACKGROUND

The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults' attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice.

OBJECTIVE

The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults.

METHODS

A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen's feasibility framework.

RESULTS

A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001).

CONCLUSIONS

The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion.

"I always prefer to withdraw than use a condom": contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney

BACKGROUND

Incidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia.

METHODS

This qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis.

RESULTS

Condomless sexual practices appear to be common among the study group based on participants' self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice.

CONCLUSIONS

The result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who  migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.

The Mediating Role of Sexual Self-Efficacy on Protected Sex

BACKGROUND

Ascribed traditional gender role has rarely been examined in the topical area of protected sex.

OBJECTIVE

The purpose of this study was to examine the relationship between HIV knowledge, ascribed cultural gender roles of machismo and marianismo, acculturation, attitudes toward risky sexual behaviors and sexual self-efficacy on protected sex, and the mediating effect of sexual self-efficacy between these predictors and protected sex.

METHODS

Part of a larger study, Hispanic college students from a Hispanic-serving institution in a U.S. southern border city were recruited.

RESULTS AND CONCLUSION

Sexual self-efficacy was found a significant mitigating factor against sexual risks associated with machismo as well as a positive reinforcing element on attitudes toward protected sex. Study findings have implications toward the development of culturally sensitive evidence-based interventions that promote sexual self-efficacy skills among Hispanic males who strongly identify with culturally ascribed gender roles.

An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial

Background

Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China.

Objective

This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students.

Methods

A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses.

Results

Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI −1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI −5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02).

Conclusions

An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach.

Trial Registration

ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679

A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study

BACKGROUND

The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear.

OBJECTIVE

The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator.

METHODS

Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator.

RESULTS

The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: -0.80, 95% boot CI -1.67 to -0.36) but not in sexual minority women (indirect effect: -0.33, 95% boot CI -0.86 to 0.31).

CONCLUSIONS

The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion.