Using the theory of reasoned action (TRA) to understand the decision to use condoms in an STD clinic population

Abstract

The theory of reasoned action (TRA) provides useful information when designing health education interventions. In this study, 703 heterosexual STD clinic clients responded to a TRA-based survey. With steady partners, social norms and attitudes toward condom use were significant predictors of intention for both men and women. The interaction of attitude and norm increased prediction for men (R = .64, p < 0.001) and women (R = .70, p < 0.001). With casual partners, attitude was a predictor for men and social norm was a predictor for women. Prior use of condoms increased prediction for men (R = .38, p < 0.001) and women (R = .47, p < 0.001). Findings suggest that, in addition to traditional TRA model variables, the relationship between sexual partners and the individual's prior experience with condom use should be incorporated into attempts to understand this complex, dyadic behavior. Examining specific outcome and normative beliefs also provides important information for intervention design.

PIP: According to the Theory of Reasoned Action (TRA), the intention to perform a specific behavior is a linear function of the individual's attitudes related to performing the behavior and perceived social norms about the behavior. The ability of this theory to predict condom use intentions was tested in 703 heterosexual men and women registered at a health department sexually transmitted disease (STD) clinic in Seattle, Washington. Although 85% reported condom use at some point, few reported regular use (defined as 2/3 of the time). 40% reported sexual contact with a casual partner in the month preceding the survey, but only 21% had used condoms regularly with these partners. 64% acknowledged intercourse with a regular partner in the preceding month and condoms were used regularly by 16%. Overall, 75% of the sample had not used condoms regularly with steady or casual partners in the preceding month. Multiple regression analyses confirmed the relevance of the TRA model in accounting for a significant amount of the variance in condom use intention. Subjects had more positive attitudes, perceived stronger norms, and had stronger intentions toward condom use with casual than steady partners. The interaction of attitude and norm increased prediction for both men and women. For men, neither social norm alone nor the interaction of norm and attitude had an effect on the intention to use condoms with casual partners. Women who requested their partner to use condoms were more influenced by social norms, while male condom users were most influenced by their own attitudes. Among both men and women, previous users were more likely to intend to use condoms (R = .38 for men and .47 among women, p 0.001). TRA concepts should be incorporated into the design of health education programs aimed at promoting the use of condoms and other risk reduction behaviors.