Sociology Homework Help
Dimensions of Self-Efficacy Among Three Distinct Groups of Condom Users
Tina M. Brien, MSEd; Dennis Colleen A. Mahoney, PhD; and
L. Thombs, PhD; Larry Wallnau, PhD
Abstract. Condom use self-efficacy can be defined as exp€cta- tions about one's ability to use condoms under a variety ol cir- cumstances, This investigation examined the factor structure of the Condom Use Self-Efficacy Scale (CUSES) in an l8- to 23-year-old college population (N = 339) and tested the ability of the lactors to distinguish among three groups of condom users (nonusers, sporadic users, and ritualistic users). Emerg- ing irom a principai componenis ana.lysis were iour reiiabie faitors labeled Mechanics, Partner's Disapproval, Assertive, and Intoxicants. Results from a discriminant malysis indicated that sporadic users were best distinguished from rituaiistic users by number of scx partners, usc of intoxicants, and inten- sity ol alcohol use. The sporadic users hTd*frot-c-sei partncrs, were less confident of their ability to use condoms when intox- icated, and were heavier drinkers than were the ritualistic users. Nonusers were best distinguished from ritualistic users by the factor labeled Assertive. Nonusers were significantly less confident in their ability to discus condoms and to insist on their use with a sexual partner. Implications of the findings for improving campus-bascd programs to prevent the spread of human immunodeficiency virus infection and sexually transmit"ted diseases are discussed.
Key Words: alcohol, condoms, hczlth education, human im- mu nodefi ciency virus, sexu ally transmitted diseases
esearch indicates that traditional-age college students (18-23 years old) are at particularly high risk for contracting sexually transmitted dis-
eases (STDs). As a group, they are likely to have multiple sexual partners and their use of condoms tends to be spo- radic.
r'2 In one college sample (N = ?n4), 3201o of the stu- dents reported having l0'or more sexual partneis in their lifetime, and l89o reported 5 or more partners in the pre-
Tina M. Bricn is educolionol coordinator of the Council on Alcoholbm and Other Chemical Dependencies of the Finger Lakes in Geneva, New York. Dcnnls L. Thombs and Collecn A. Mahoncy are both asistant proJeson in the Deparlmenl of Heallh kicnce ol the Stote Univenity of New York in Brockport, where Ltry lyalbtut b an osociote profesor in the Department of PsYchologt-
WL12, JANUARY 1994
vious l2 months.' Unfortunately, regular use of condoms is reported by relarively small proportions of college stu- dent samples (890 to 410/o).2'1 Condom use during an in- itial sexual encounter with a new partnor also docs not seem to be the norm. Freimuth et alr found that 56q0 of a college student sample had not used a condom during their most recent episode of sexual intercourse with a new partner. College students also tend to be frequent con- sumers of alcohol, and alcohol use has bcen found to bc related to lower levels of condom usc.{
The relatively low rare of condom use among college students cannot be blamed on inadequate knowledge about STDs or safer s€x practices. Several studirx have demonstrated thar college students have relatively high levels of knowledge about human immunodeficiency vims (HI$, in particular, its transmission, and how to prevent it.r7 Many college students, however, appcar to have difficulty in translaling this knowledge into actions that protect their health. This is not particularly surpris- ing, given that most STD/HIV prevention programs have not emphasized skill enhancemeht a-s an essential feature
of their intervention efforts.r A skills-based approach would be likely to include enhancement of assertiveness and negotiation skills, ways to cope with rejection fears' instruction in the mechanics of using a condom, and methods to make scx safer, even though the user might b€
intoxicated. Many young adults may lack confidence in
their ability to use condon$ on a consistent basis bccause they have never received explicit instruction in using con'
doms skillfulty An important Line of inquiry in this area pcrtains to
condom use self-efficacy.E A componcat of socid lcarn- ing theory, self-efficacy is dehned as a bclief or judgment
aiut one's own ability to execute a spccifrc coursc of action.e Individuals who possess high scf+ff]cacy with
respcct to a task arc likely to err8agi in thsr bchavior' Thosc who have littlc confidence in their ability will prots
ably avoid the activitY.
167
C()-]-63€ HEALTH
In re3ard to condom use, Braiiord and Beck' have re- poned that condom us€rs possess sigrufica,rtly srronger self-efficacy than rhose who do nor use condoms. Braf- lord aad Beck's unidimensiona.l Condom Use Self-Effi- cacy Scaie (CUSES) was found to be convergenrly valid, as demonstrated by its relatioruhip to other scales meas- gring condom arrd contraceptive use. The CUSES also possessed a high degree of inrernal consistency (.91) and temporal stability over,a 2-week p€riod (.8I).t Brafford and Beck's work was the hrst step in the systematic inves- tigation of condom use self-efficacy, and their findings suggestd that the self-efficacy model is a potentially use- ful framework for diveloping more effective HIV/STD prevenlion programs on campus.
In the present study, we extended the work of Brafford and Beckt in three ways. First, we factor analyzed the 28 items of the CUSES to determine whether there were un- derlying dimensions to the construct of condom use sclf- efficacy. Second, we uscd a more sophisticared schemelo classify condom usen. Brafford and Beckt tested the ability of the CUSES to discriminare berween just two groups (usen and nonusers). Our present study consid- -ered
three groups: nonus€rs, sporadic users, :md ritualis- tic usen. This grouping allows for distinctions zrmong those college students who always use condoms, thosc who sometimes use them, and those who never do so. Finally, our study employed a muitivariarL daia anajytic approach. We tested the ability of sclf-efficacy facton, hig.h-risk behavion (eg, number of sexual partners and in- tensity of aicohol use), and demograptric measures to dis- tingurslt among the three condom-user Sroups. Together, these procedures provide a close examination of the rela- tions between specific dimensioru of condom-use self- efficacy and different condom-usc patterns. Understand- ing these relations may be important in designing HIV/ STD prevention programs that can tailor interventions thar enhance self-efficacy to different -condom user SrOups.
HETHOD
Frocedures
After receiving human subjects''approvai from the In- stitutional Review Board, wc administered an anony- mous questionnaire to studentJ at a public university in western New York Stare during the first 6 months of 1992. The questionnaire was completed in a wide variety of academic courses (business administrarion, criminal justice, health education, psychology) and at fraternity chapter meetinSs. Random sclection procedures w'ere not used -to- form the sample. This introduced uncertainty about the repiescntativeness of the sample. The advan- tage of the convenience sample, however, was that it ai- Iowed the respondents greater assurancc that their re- spons€s werc tn:Iy anonymous. Random sclection pro€- duies (eg, rnaii or telephone surveys) tend to undermine a-surances of anonyrnir,o or confldentiality. Given tlie c.-siti'-,e niirrF arc i.r+ nrr,<-'innrtiip if :':rs anr": nrtr ri.-!irc
'. a':
to obtain va-Lid self-repon dara, we opted to use a conven- ience sample.
We emphasized to studenb rhar their parricipation h the study was.volunlary. Responxs were recorded on op- tical scan answer sheets. We believe this allowed students privacy in responding to the questionnaire. Each rime the
-questionnaire was administered, students were instructed not to respond to the quesrionnaire if they had already done so in another class. Many students complied with this request. Because we were interested in the factors at-- fecting condom usc in the tradirional college-age popula- tion, we performed our data analyses on a subsample comprising l& to 23-year-old students
In the study, we use,i a number of single-item meas- ures. Each respondent reported the number of different paflners with whom they had sex in the previous 12 months, using a lGpoint scale ranging from none (0) to nine or more (9). Response options for sexual orientation included heterosexttql, homossual bisexual, and un- sure. A history of having been diagnosed with a rxually transmitted disease was assessed with the respons€ op- tions: yes, no, and Ltn-rute. A singJe aspect of condom usc knowledge was assessed with the question, "Which of the following offers the Dest protection against sexually transmitted diseases?" The correct answer (latex'con- doms and nonoxynol-g spermicide) was accompanied by four other "distracter" respons€ options, as well as the option I don't know. Respondents reported 1i1e;I age at the time of thet first scxual intercoursc expcrience, us- ing a lGpoint scale ranging from /J or younger (0) to 22 or older (9). If the respondents had ever used a condom during sexual intercours€, they reported their age at f,irst use with a scale identical to the one described in the pre- vious item.
Cordom- User Chssillcatbn .
The criteria for classifying respondents into condom- us€r groups were establiched on the basis of responses to four questionnaire items. The groups were defined in the following manner.
Nonusen: (l) had I or more sexual partnen in the pre- vious 12 months, (2) reported no us€ of condoms with aay "hrst-time" partner, (3) reported no continud us€ with any sexual partner, and (4) reported having no part- ner with whom condoms were always used.
Sporadic users: (l) had I or more sexual panners in the previous 12 months, (2) reported using a condom with at least I partner in the previous 12 monlhs, and (3) report- ed having more total sexua.l partnen than partners with whom they always used a condorn.
.Rilualistic users: (1) had I or more rxual partnen in the previous l2 months, and (2) reported having the same number of sexual partners as partners with whom they al- wa-vs used a condom.
@
co!rcA4 SA_@nAcy
TABLE 4 Clsestflcstion Anatyeis of Groupc of Condonr-.Ueers
Actual group membership
Predicted us€r group Nonusers Sporadic
n9s futuaiisric
slc9o
Nonusers Sporadic usen fu1ualic1i6 uscrs
l7 36 5l
9 't2
l0
56 30 l4l 33 78 17
53.6 23.4 21.8
l6.l 51.1 t2.8
30.4 25.5 65.4
Notc.' Perccntag of cascs correct.ly classified by uscr group = 55.64rh.
DISCUSSION
The results of rhis srudy have to be quaiified by the limitation of having used a convenience sample. General- izing the furdings to the larger college population, there- fore, must be done cautiously. This study, however, does build on the work of Brafford and Beckt by providing additional and more compeiling evidence of the discrinni- nant validity of the CUSES. Our study also repiicates their work by demonstrating that the instrument pos- sesses sou nd psych o metric characteristics (aCequate Lrter- nal consistency, relatively independent subscales, and freedom from social desirability bias).
Results from the factor analysis indicate thar condom- use self-efficacy is a multidimensional construct. Four re- Iiable factors emerged from the analysis. These four fac- tors clarify the complex nature of cohdom-use self-effica- cy, and they capture many of the sensitive issues involved in intimate sexual encounters.
Findings of the discriminant analysis indicate rhat rhe nurnber of sexual partners is very irnportarit in distin- guishing sporadic from ritualistic users of condoms. The former group had, on average, 3.64 sexual partnen in the previous 12 months, compared with l.92 partners in the latter group. That thosc with the greaier number of sex- ual partners (the sporadic users) were less likely to use condonN may be partly eplained by their heary use of alcohol and their Iack of confidence in their ability to us€ condoms when intoxicated. This hnding is consistent with previous research that has shown that intoxication is related to diminished condom use in young people. Hing- son, Strunin et al1 found that heavy drinkers (lGl9 yean old) were 2.8 times Iess likely to use condorns rhan were light drinkers. Furthermore, arnong those who reportd ever enSaging in sexuai intercoursc after drinking, con- dom use was more frequent when drinking did not occur. Alcohol use is also rekited to number of sexual partners. In this study, the two variables werc significantly corre- lated (r - .45, p < .01, n : 275). Thesc irndings suggest that college progfiuru that promote condom use must ad-
VOL12, JANUARY 1994
dress alcohol abusc and how it is relared to mu-ltiple scx- ual partncrs.
The nonusers were most different from the ritualistic us€rs on the asscrtive self-cfficacy subscale, indicafing that thosc in the former group were less confident in their abiiity to insist that their partner use a condom. partner's disapprovai was also a moderately important discrimina- tor, in the same direction, for thesc two goups. Togah- er; thesc two self-efficacy variabies reveal differences in communication skills. tt appcars that nonuscrs, as a Eioup, Iackoi confidence irr their abiiities to discuss anci insist on condom use and to negotiate and rcsolve any conflict about their use; they also feared partner rejec- tion. The ritualistic users, in contrast, were much more confident about their skills in these aspc.cts of intimate communication. These Furdings are similar to those of Freimuth et d,r who found that communication self- efficacy was the best discriminator between thosc who do initiate discussion about condom use and those who do not do so.
Although it is entirely specularion, it appears rhat the differences between the nonuscrs and the ritualistic uscrs may also reflect the ty'pcs of relationships thar members of these two groups form with partners. The ritualictic us€rs may form healthier relationships that are character- ized by op€nness and mutual respect, Power imbalancc and pcrsonal insccurity may b9 greatil features in the relationships of the nonusers./ Ne_vgrtheless. our results indicate that communication And enhancement of rela-
-
tionship skills-need Lo_U. e major componenr of pro. grami to promote use of condoms to nonusers.
In both the univariate and multivariate analysA, me- chdnics did not distinguish among the three condom-uscr groups. This indicates that the mechanical aspects of us- ing a condom are ndt important barriers to their actual use. The data we have prescnted here show that the bar- riers are more closely related to intoxicafion, emotion l concerns, communication and relationship problems, and a lack of confidence in one's abilitics to dcat lyith thesc issues. Our hndings also suggest that STD/HIV
.-prevention programs on campus must go bcyond teach- ing the mechanics of condom use. To enhance sclf-cffi- f\ cacy, STD,THIV prwention prograrns must stress dev* ( C/
|n'-J
oping skills in rekrionships, communication, and conflh iesolution and negotiarion as essential components. Stu_ dents need ro be giren opponunities ic practice rhese skills and to experience rheir success as a \\'ay ol increas- ing the likelihood that rhey will use these skilis in intimate encounters.
We found thal gender was not important in distin- guishing among the three condom-user goups, an indica- tion that there may be no gender-specific issues that in- fluence condom use in the college-age popuiation. We recommend, therefore, that intervention prograrns bring women and men together for educational activities that allow for realistic scenarios in which students can discuss concerns and practice skills.
Finally, prograrru need to address student health issues in a comprehensive rather than fragmented manner. Findings from this study (as well as others) suggest that alcohol usc, sexual actirrity, and unsafe scx practices often occur together. Interventions, therefore, must ad- dress aII of the many patterns of behavior that contribute to high-risk lifestyles.
NOTE
This study is bascd on a thesis submitted by the hrst author under the direction of the sccond author in partial fulfillment of the requirements for a master's degree from the Stare Uni- versity of New York-Brockport. Dr Larry Wallnau is grateful to SUNY-Brockport for his sabbatical leave, which occurred during the coursc of this study.
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