Paper
Tuesday, November 6, 2007
578
Rural African-American Stimulant Users' Condom Use Self-Efficacy, Decisional Balance, and Stages of Change
Donna L. Gullette, DSN, RN, College of Nursing, University of Arkansas Medical Sciences, Little Rock, AR, USA, Katharine E. Stewart, PhD, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Brenda M. Booth, PhD, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA, LeaVonne Pulley, PhD, MEd, BA, College of Public Health-Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA, and Patricia B. Wright, MPH, BSN, RN, Division of Health Services Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| Learning Objective #1: identify the various stages of change associated with condom use among rural African American stimulant users. |
| Learning Objective #2: understand how decisional balance and self-efficacy contribute to patterns of condom use with main and casual partners, |
Background: The Southern United States has a higher HIV incidence rate
(14.7/100,000) than all other US regions. The 2005 HIV incidence rate for African
Americans in Arkansas was 4.98 times that of Whites. Rural African American stimulant
users are at especially high risk, and urgently need effective sexual risk reduction
interventions. Yet, very few interventions have been tested in this population.
Purpose: This study applied the Transtheoretical Model (TTM) to sexual risk behaviors
in rural African American stimulant users to identify stages of change (SOC) associated
with condom use with main and casual partners, and to understand how self-efficacy
and decisional balance are related to SOC.
Method: Seventy-two participants (50% women) completed computer-assisted personal
interviews using validated questionnaires focused on TTM constructs for condom use
with main and casual partners.
Findings: Most participants (77%) had a main sexual partner and more than half (54%)
had at least one casual partner. Most of the participants (65%) were in earlier SOC
(precontemplation, contemplation) for condom use with a main partner; but 59% were in
the maintenance SOC for condom use with casual partners. Participants with higher self-
efficacy (p<.0001) and who perceived more advantages (p<.05) for using a condom with
a main partner were in the “action” or “maintenance” SOC. Likewise, perceived
advantages (p<.0002) and higher self-efficacy (p<.0005) were associated with SOC for
condom use with casual partners.
Conculsions: TTM constructs are useful in understanding patterns of condom use with
main and casual partners. Self-efficacy was a particularly strong predictor of SOC.
Implications: Interventions that focus on increasing self-efficacy for condom use with
main partners may be more effective than those focused on changing decisional
balance. Therefore, all sexual risk reduction interventions must address the important
cultural and social influences on patterns of sexual behavior in target populations.