Exploration of five condom-related behaviours in the UK: Development and evaluation of a theory-based online safer sex intervention

  • Judith Hancock

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

To prevent unwanted pregnancies and sexually transmitted infections, sexually active individuals should practice safer sex (World Health Organisation 2008). This is important across the lifespan (Nusbaum and Rosenfeld 2004). But older and heterosexual populations are typically overlooked in safer sex interventions (Bodley-Tickell et al. 2008; Bowleg 2011). The Theory of Planned Behaviour (TPB) has been used to predict behaviour, and develop safer sex interventions (Fishbein and Ajzen 2010). But a criticism of the TPB is that it fails to recognise the emotional aspect of safer sex (Norton et al., 2005). Extending the TPB to include affective attitudes has enhanced the effectiveness of safer sex
interventions (Ferrer et al. 2011). Furthermore, safer sex typically involves a series of five condom-related behaviours; accessing, carrying, negotiating, using and disposing (Moore et al. 2006). Yet most interventions promote only one condomrelated behaviour. In addition, the internet is now being used more as a platform
for delivering interventions (Kraft and Yardley 2009). For safer sex interventions, online delivery may help reduce the embarrassment individuals often report when discussing sexual health (Qulliam 2011). Therefore, the aim of this thesis was to develop and evaluate an online safer sex intervention to promote performance of multiple condom-related behaviours in a broad population.

A series of studies were conducted in order to develop the intervention. Study 1,an online elicitation study with 26 individuals, used an extended TPB framework to explore attitudinal, normative and control beliefs toward performing five condom-related behaviours. Findings suggested that individuals hold a range of attitudinal, normative and control beliefs toward performing these condom-related behaviours. Study 2, an online questionnaire study with 363 individuals identified beliefs and behaviours for intervention target. Findings suggested that three condom-related behaviours should be promoted; carrying, negotiating and using.
In addition, analysis showed that affective and moral norm beliefs were most predictive of intention to perform these three condom-related behaviours, and should be the intervention targets. Study 3 was an online intervention with 439 individuals. Individuals were randomised to one of three conditions; control message, positively- or negatively-framed persuasive message. TPB and self-report behaviour measures were taken pre-, immediately post-intervention and three months later. Findings demonstrated that performance of condom-related behaviours did not significantly increase from participation in the intervention. However, intention to carry and use condoms increased over time regardless of
intervention condition in all populations sampled.

Overall, findings from this thesis support the development of safer sex interventions that promote multiple condom-related behaviours in a broad population. However, findings suggested that persuasive messages targeting psychological constructs of the TPB do not change intentions better than a control message in a broad population. From a public health perspective, these
findings suggest that highlighting the benefits of performing condom-related behaviours may be sufficient to strengthen intentions. These strengthened intentions may be protective in the future if the situation arises for an individual which requires the performance of these behaviours. Recommendations for future safer sex research are considered.

Date of Award2013
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorKatherine Brown (Supervisor) & Martin Hagger (Supervisor)

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