Health belief and self-efficacy models: their utility in explaining college student condom use

AIDS Educ Prev. 1995 Feb;7(1):32-49.


This investigation tested the ability of the Health Belief Model (HBM), dimensions of self-efficacy, various behavioral variables (i.e., number of sex partners in the past 12 months, frequency of drunkenness during sexual intercourse, and number of diagnosed sexually transmitted diseases), and demographic measures to distinguish between three condom user groups (i.e., nonusers, sporadic users, and consistent users). The usable sample consisted of 366 college students, ages 18 to 24. The study operationalized the following HBM components: perceived susceptibility, perceived benefits, and perceived barriers. The multidimensional Condom Use Self-Efficacy Scale (CUSES) was also used in this investigation. Results from a discriminant analysis indicated that sporadic users were best distinguished from both consistent and nonusers by number of sex partners in the past year, frequency of drunkenness during sexual intercourse, perceived susceptibility to HIV/AIDS and other STDs, and a self-efficacy factor labeled Assertive. The sporadic users had significantly more sex partners, were drunk more often when engaging in sexual intercourse, perceived themselves as more susceptible to HIV/AIDS and other STDs, and were less confident in their ability to discuss and insist on condom use with a partner. It was also discovered that each condom user group was best defined by different subsets of discriminating variables. Implications of these findings for campus-based prevention programs and future research are discussed.

PIP: The ability of the health belief model and self-efficacy concept to discriminate among three condom use groups--nonusers, sporadic users, and consistent users--was assessed in a sample of 366 sexually active college students 18-24 years of age. The mean number of sex partners in the 12 months preceding the survey was 2.2. The students could be classified as follows: nonusers, 70 (19%); sporadic users (defined as having more total sex partners in the preceding year than partners with whom a condom was always used), 157 (43%); and consistent users, 107 (29%), Principal components factor analyses of the health belief model constructs indicated that perceived benefits, perceived barriers, and perceived susceptibility are multidimensional. In univariate analyses, statistically significant differences across condom use groups were found for the following measures: perceived susceptibility of partner, perceived susceptibility of self, assertiveness, partner disapproval of condoms, intoxicants, number of sex partners, and inebriation during sexual intercourse. When a multiple discriminant function analysis was conducted with these variables, they failed to differentiate significantly between nonusers and consistent users but did distinguish sporadic users. Sporadic condom users perceived themselves and their partners as at highest risk of acquired immunodeficiency syndrome and other sexually transmitted diseases, had the largest number of sex partners in the past year, reported more inebriation during sexual intercourse, and were less confident in their ability to negotiate condom use with a partner than their counterparts in the other two use groups. Out of the variable subsets, the health belief model was best at identifying sporadic users, behavioral variables were most pertinent for nonusers, and the self-efficacy measure was most relevant in the case of consistent use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attitude to Health*
  • Condoms*
  • Female
  • HIV Infections / prevention & control*
  • HIV Infections / psychology
  • HIV Infections / transmission
  • Health Behavior
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Internal-External Control
  • Male
  • New York / epidemiology
  • Risk Factors
  • Self Concept*
  • Students / psychology*