Paper
Friday, July 13, 2007
Application of the Transtheoretical Model to Sexual Risk in Rural African American Stimulant Users: Critical Differences with Main and Casual Partners
Donna L. Gullette, DSN, RN1, Katharine E. Stewart, PhD, MPH, MA, BS2, LeaVonne Pulley, PhD, MEd, BA3, Patricia B. Wright, MPH, BSN, RN4, Brenda M. Booth, PhD5, and Zackary Feldman, MS4. (1) College of Nursing, University of Arkansas Medical Sciences, Little Rock, AR, USA, (2) College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA, (3) College of Public Health-Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA, (4) Division of Health Services Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA, (5) Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| Learning Objective #1: identify the critical differences in the stages of change for condom use with main and casual partners. |
| Learning Objective #2: understand how decisional balance and self-efficacy play a key role in determining various stages of change |
Background: The Southern United States has the highest HIV incidence rate (14.7) compared to other US regions (11.6). The 2005 HIV incidence rate for African Americans in Arkansas was 4.98 times that of whites. Stimulant users are at risk for sexually transmitted infections (STIs) and HIV. Rural African American stimulant users are at extremely high risk and urgently need effective sexual risk reduction interventions. However, very few interventions have been designed or tested in this population.
Purpose: This study applied the Transtheoretical Model (TTM) of behavior change to sexual risk behaviors in rural African Americans stimulant users to identify stages of change (SOC) associated with condom use with main/casual partners, and to understand how self-efficacy, and decisional balance are related to risk behaviors.
Method: Seventy-two rural African American stimulant users (50% female) completed computer-assisted personal interviews on theory-based individual and social determinants of sexual risk behavior in determining various SOC.
Findings: Fifty-seven percent of the participants reported using crack cocaine and 72% used powder cocaine. Nearly 70% used stimulants during sex, 61% reported inconsistent condom use, and 63% revealed trading sex for drugs, money and/or other needs. Participants with higher self-efficacy for condom usage with their main partners were more in the “action” or “maintenance” SOC (p<.001). Participants were in a higher SOC with main partners (p<.002) when perceived benefits outweighed perceived barriers even though significantly less condoms were used with main partners than with casual partners. Self-efficacy for condom use with casual partners was associated with a higher SOC (p<.001).
Implications: The TTM was useful in determining the SOC associated with condom use with main and casual partner as well as identifying how self-efficacy and decisional balance was related to sexual risk behaviors. This information is useful in developing a TTM-based behavioral intervention to reduce sexual risk and STIs/HIV.