Relationship between social cognitive theory constructs and self-reported condom use: assessment of behaviour in a subgroup of the Safe in the City trial

Margaret C Snead; Ann M O'Leary; Michele G Mandel; Athena P Kourtis; Jeffrey Wiener; Denise J Jamieson; Lee Warner; C Kevin Malotte; Jeffrey D Klausner; Lydia O'Donnell; Cornelis A Rietmeijer; Andrew D Margolis

doi:10.1136/bmjopen-2014-006093

Relationship between social cognitive theory constructs and self-reported condom use: assessment of behaviour in a subgroup of the Safe in the City trial

BMJ Open. 2014 Dec 30;4(12):e006093. doi: 10.1136/bmjopen-2014-006093.

Affiliations

¹ Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Division of HIV/AIDS, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ California State University, Long Beach, California, USA.
⁴ UCLA David Geffen School of Medicine and Fielding School of Public Health, Los Angeles, California, USA.
⁵ EDC, Waltham, Massachusetts, USA.
⁶ Colorado School of Public Health, Denver, Colorado, USA.

Abstract

Objectives: Previous studies have found social cognitive theory (SCT)-framed interventions are successful for improving condom use and reducing sexually transmitted infections (STIs). We conducted a secondary analysis of behavioural data from the Safe in the City intervention trial (2003-2005) to investigate the influence of SCT constructs on study participants' self-reported use of condoms at last intercourse.

Methods: The main trial was conducted from 2003 to 2005 at three public US STI clinics. Patients (n=38,635) were either shown a 'safer sex' video in the waiting room, or received the standard waiting room experience, based on their visit date. A nested behavioural assessment was administered to a subsample of study participants following their index clinic visit and again at 3 months follow-up. We used multivariable modified Poisson regression models to examine the relationships among SCT constructs (sexual self-efficacy, self-control self-efficacy, self-efficacy with most recent partner, hedonistic outcome expectancies and partner expected outcomes) and self-reported condom use at last sex act at the 3-month follow-up study visit.

Results: Of 1252 participants included in analysis, 39% reported using a condom at last sex act. Male gender, homosexual orientation and single status were significant correlates of condom use. Both unadjusted and adjusted models indicate that sexual self-efficacy (adjusted relative risk (RRa)=1.50, 95% CI 1.23 to 1.84), self-control self-efficacy (RRa=1.67, 95% CI 1.37 to 2.04), self-efficacy with most recent partner (RRa=2.56, 95% CI 2.01 to 3.27), more favourable hedonistic outcome expectancies (RRa=1.83, 95% CI 1.54 to 2.17) and more favourable partner expected outcomes (RRa=9.74, 95% CI 3.21 to 29.57) were significantly associated with condom use at last sex act.

Conclusions: Social cognitive skills, such as self-efficacy and partner expected outcomes, are an important aspect of condom use behaviour.

Trial registration number: clinicaltrials.gov (NCT00137370).

Keywords: PUBLIC HEALTH; SEXUAL MEDICINE; SOCIAL MEDICINE.

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Publication types

Controlled Clinical Trial
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Cognition*
Condoms / statistics & numerical data*
Female
Follow-Up Studies
Health Knowledge, Attitudes, Practice*
Humans
Male
Marital Status
Psychological Theory
Safe Sex*
Self Efficacy*
Self Report
Sex Factors
Sexual Behavior
Sexual Partners*
Sexuality
Sexually Transmitted Diseases / prevention & control*
Social Control, Informal
Young Adult

Associated data

ClinicalTrials.gov/NCT00137370