Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unintended pregnancy.

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

PIP: The authors assessed the applicability of the transtheoretical model of behavior change to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Data were collected in 1992 from the US Centers for Disease Control's multisite Prevention of HIV in Women and Infants Demonstration Project. In the transtheoretical model, which originated from smoking cessation and psychotherapy research, behavior change is a gradual, continuous, dynamic process in which people move through a sequence of five stages. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess the use of oral contraceptives and hormonal implants, but that measurement of condom use requires separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. SE scores rose significantly across stages, from recontemplation to maintenance, and a shift in decisional balance was observed for two of three behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

Assessing the stages of change and decision-making for contraceptive use for the prevention of pregnancy, sexually transmitted diseases, and acquired immunodeficiency syndrome.

A synergistic approach was taken to examine contraceptive use adoption for two related behaviors: pregnancy prevention and the prevention of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). One hundred twenty-three young adults responded to questionnaire items based on two constructs from the Trans-theoretical Model of Change, the Stages of Change and Decisional Balance, as well as other pertinent variables. In Phase 1, two Decisional Balance measures were developed: One for the prevention of pregnancy and one for disease prevention. Final versions of both measures consisted of two 10-item scales: one representing the positive aspects (PROS) and one representing the negative aspects (CONS) of contraceptive and condom use. In Phase 2, the same individuals were staged for both pregnancy and disease prevention according to their readiness to change for contraceptive and condom use. MANOVAs and ANOVAs indicated that the PROS and CONS for both measures were related to stage of change for both contraceptive and condom use. Results from this pilot study were consistent with prior applications of the Trans-theoretical Model to the cessation of such problem behaviors as smoking and to the adoption of positive health behaviors such as exercise acquisition.

PIP: The authors adopted a synergistic approach to explore the adoption of contraceptive use for the prevention of pregnancy and the transmission and contraction of sexually transmitted diseases (STD). 123 students from a freshman level psychology course at a northeastern university were sampled via questionnaire in 1992. Questionnaire items were based upon 2 constructs from the Transtheoretical Model of Change, Stages of Change and Decisional Balance, and other pertinent variables. Subjects were of average age 19.87 years in a range of 18-25; 62% were female; 95% were Whites; and 99% reported being heterosexual. 87% had engaged in oral and vaginal intercourse, and 14% had experienced anal intercourse. 39% reported having 5 or more sex partners since becoming sexually active. 17% reported to be currently having vaginal intercourse with someone in addition to their main or steady sex partner; 10% had been diagnosed with an STD at one time; and 14% stated that a pregnancy had occurred in one of their relationships. 2 Decisional Balance measures were developed in phase 1. In phase 2, the subjects were staged for pregnancy and disease prevention according to their readiness to change for contraceptive and condom use. It was found that the pros and cons for both measures were related to stage of change for both contraceptive and condom use.