Predicting condom use in adolescents: a test of three socio-cognitive models using a structural equation modeling approach.
ABSTRACT: The theory of planned behavior (TPB), socio-cognitive model (SCM), and information-motivation-behavioral skills (IMB) model are effective in predicting condom use. However, the adequacy of these three theoretical models in predicting the frequency of condom use (FCU) among young people has not been compared. This cross-sectional study tested the applicability and suitability of these three models in predicting the FCU, and analyzed the relationships among the postulated constructs.Sexually experienced adolescents (n = 410) aged 13-18 completed a survey assessing the TPB, SCM, and IMB model constructs. Participants were students recruited from 18 high schools, randomly selected from the north, south, east, and southeast of Spain. A structural equation modelling (SEM) analysis was applied to test TPB, SCM and IBM and constructs relationships of each model using R.The results of SEM demonstrated that behavioral skills predict behavior via motivation as hypothesized by the IMB model, but not directly via knowledge about condom use and sexually transmitted infections (STIs). Cognitive factors, such knowledge about condom use and STIs as well as condom use self-efficacy, directly predicted the FCU when modeled as per the SCM. According to the TPB, condom use intention was the best predictor of the FCU, and condom use intention was predicted by attitudes toward condom use and subjective norms related to condom use, but perceived control was not directly or indirectly related to the FCU. Based on the data, the TPB becomes the best-fit model for predicting the FCU among young people compared to the SCM and IMB model.From a statistical perspective, the TPB seems to be the most suitable model for predicting the FCU among young people compared to the other models. Overall, key direct predictors of the FCU in adolescents included condom use intention, behavioral skills and cognitive factors, such as STIs knowledge and condom use self-efficacy. The next step should be to test integrative models that include personal, contextual, environmental, and social factors.
Project description:BACKGROUND:Men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection in China. Correct and consistent condom use is one of the most effective strategies for preventing the spread of HIV. This study developed a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behavior among Chinese MSM. METHODS:A cross-sectional study was conducted to collect data using self-administered electronic questionnaire. Participants were recruited from HIV Voluntary Counseling and Testing clinics in six district Centers for Disease Control and Prevention in Guangzhou and two community-based HIV service centers (Lingnan Partners and Zhitong Charity) from May to September 2017. Structural equation modeling was performed to develop the modified IMB model with extended multilevel factors. RESULTS:Among the 976 MSM included, 52.05% had engaged in anal intercourse with a condom every time. The final modified IMB model fitted the data more ideally than the conventional model. The final modified IMB model revealed that behavioral skills positively contributed directly to condom use (β = 0.385, p < 0.001) and partially mediated the associations between information (β = 0.106, p = 0.005) and motivation (β = 0.390, p < 0.001) and condom use. Regarding the extended multilevel factors, education, income, receiving HIV prevention services, sexual partner seeking behavior, depression, intimate partner violence, and child sexual abuse had indirect impacts on condom use that were mediated by information, motivation, and/or behavioral skills (p < 0.05). All paths from the latent variable to the corresponding observed variables were statistically significant (p < 0.001). CONCLUSION:The modified IMB model with extended multilevel factors could serve as a theoretical framework for behavioral interventions for condom use among Chinese MSM. Further prospective studies are needed to examine the predictive power of the modified IMB model.
Project description:BACKGROUND: High prevalence of risky sexual behaviors and lack of information, skills and preventive support mean that, adolescents face high risks of HIV/AIDS. This study applied the information-motivation-behavioral skills (IMB) model to examine the predictors of consistent condom use among senior high school students from three coastal cities in China and clarify the relationships between the model constructs. METHODS: A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behaviors among senior high school students in three coastal cities in China. Structural equation modelling (SEM) was used to assess the IMB model. RESULTS: Of the 12313 participants, 4.5% (95% CI: 4.2-5.0) reported having had premarital sex and among them 25.0% (95% CI: 21.2-29.1) reported having used a condom in their sexual debut. Only about one-ninth of participants reported consistent condom use. The final IMB model provided acceptable fit to the data (CFI = 0.981, RMSEA = 0.014). Consistent condom use was significantly predicted by motivation (? = 0.175, P < 0.01) and behavioral skills (? = 0.778, P < 0.01). Information indirectly predicted consistent condom use, and was mediated by behavioral skills (? = 0.269, P < 0.05). CONCLUSIONS: The results highlight the importance of conducting HIV/AIDS preventive health promotion among senior high school students in China. The IMB model could predict consistent condom use and suggests that future interventions should focus on improving motivation and behavioral skills.
Project description:BACKGROUND: Due to the increase incidents of premarital sex and the lack of reproductive health services, college students are at high risk of HIV/AIDS infections in China. This study was designed to examine the predictors of consistency of condom use among college students based on the Information-Motivation-Behavioral Skills (IMB) model and to describe the relationships between the model constructs. METHODS: A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behavior among college students in five colleges and universities in Nanjing, China. An anonymous questionnaire survey was conducted for data collection, and the structural equation model (SEM) was used to assess the IMB model. RESULTS: A total of 3183 participants completed this study. The average age was 19.90 years (SD?=?1.43, range 16 to 25). 342 (10.7%) participants of them reported having had premarital sex, among whom 30.7% reported having had a consistent condom use, 13.7% with the experience of abortion (including the participants whose sex partner has the same experience), 32.7% of participants had experience of multiple sex partners. The final IMB model provided acceptable fit to the data (CFI?=?0.992, RMSEA?=?0.028). Preventive behavior was significantly predicted by behavioral skills (??=?0.754, P<0.001). Information (??=?0.138, P<0.001) and motivation (??=?0.363, P<0.001) were indirectly affected preventive behavior, and was mediated through behavioral skills. CONCLUSIONS: The results of the study demonstrate the utility of the IMB model for consistent condom use among college students in China. The main influencing factor of preventive behavior among college students is behavioral skills. Both information and motivation could affect preventive behavior through behavioral skills. Further research could develop preventive interventions based on the IMB model to promote consistent condom use among college students in China.
Project description:BACKGROUND: Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. METHODS: Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. RESULTS: All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. CONCLUSION: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour. However, a number of conceptual and methodological challenges remain.
Project description:Women who experience intimate partner violence (IPV) are at increased risk for HIV infection. To further the understanding of the dyadic factors that impact condom use among women, we investigated the impact of three relationship factors (i.e., power, fear, and dependence) on the association between HIV-related information, motivation, and behavioral skills [constructs from the information-motivation-behavioral skills (IMB) model] and condom use among abused women. Data from 133 urban, low-income women recruited from several community-based agencies (e.g., domestic violence agencies, women's health organizations, hospitals, Department of Health and Human Services, and Family Court) showed that these women experienced high levels of IPV and that relationship power, fear of abuse, and partner dependence were all associated with condom use. Multivariable models revealed that fear of abuse and partner dependence moderated the association between IMB constructs and condom use but relationship power did not. Results highlight the critical need to incorporate strategies to address relationship factors in HIV prevention programs with abused women.
Project description:The Theory of Planned Behaviour (TPB) assumes the possibility of predicting and explaining humans' behaviour by identifying their intentions. The intentions are shaped by three groups of factors: attitudes towards, social norms and perceived behavioural control over the behaviour. The aim of the research is to examine the applicability of the TPB in medical tourism and to check whether there are differences in predicting the intentions of medical tourists from different countries. The study covered potential medical tourists-521 young consumers from three regionally important markets in medical tourism services: Jordan, Poland and Turkey. The study used a research survey to collect data, which were analysed using the multiple regression and analysis of variance methods. The research showed that the TPB model can be used in medical tourism. The results also show that the consumers' country of origin is a significant factor when predicting their intention to use medical tourism services.
Project description:BACKGROUND:Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies. AIMS:This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy. METHODS:We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11-19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the I2 statistic and its associated 95% confident interval. RESULTS:Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges'g = 1.01), attitudes (g = 0.29), self-efficacy toward condom use (g = 0.22), intention to refuse sex (g = 0.56), condom use intention (g = 0.46), and condom use (g = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (g = 0.47). Moderators of the efficacy are discussed. CONCLUSIONS:Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.
Project description:To systematically review the Theory of Planned Behaviour studies predicting self-care intentions and behaviours in populations with and at-risk of diabetes.A systematic review using six electronic databases was conducted in 2013. A standardised protocol was used for appraisal. Studies eligibility included a measure of behaviour for healthy eating, physical activity, glucose monitoring, medication use (ii) the TPB variables (iii) the TPB tested in populations with diabetes or at-risk.Sixteen studies were appraised for testing the utility of the TPB. Studies included cross-sectional (n = 7); prospective (n = 5) and randomised control trials (n = 4). Intention (18%-76%) was the most predictive construct for all behaviours. Explained variance for intentions was similar across cross-sectional (28-76%); prospective (28-73%); and RCT studies (18-63%). RCTs (18-43%) provided slightly stronger evidence for predicting behaviour.Few studies tested predictability of the TPB in populations with or at-risk of diabetes. This review highlighted differences in the predictive utility of the TPB suggesting that the model is behaviour and population specific. Findings on key determinants of specific behaviours contribute to a better understanding of mechanisms of behaviour change and are useful in designing targeted behavioural interventions for different diabetes populations.
Project description:Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians.Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories.Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance explained by individual theories was TPB 25.0%, SCT 21.5%, CS-SRM 11.3%, OLT 26.3%, PAP 2.6%, and knowledge 2.3%, and in the cross-theory analysis constructs from TPB, SCT, CS-SRM, and OLT explained 33.5% variance in intention. Together these results suggest that physicians' beliefs about consequences and beliefs about capabilities are likely determinants of lumbar spine x-ray referrals.The study provides evidence that taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour. However, a number of conceptual and methodological challenges remain.
Project description:Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner's sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people's intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24?years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen's Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12?months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior.