Contraceptive and condom use for the prevention of pregnancy, STDs, and AIDS: A transtheoretical approach

This research involved three independent samples with over 600 heterosexually active individuals and examines the applicability of the Transtheoretical Model of Behavior Change to contraceptive and condom use behavior. The pilot study involved 123 college men and women. Measures representing two of the major constructs from the model, stages of change and decisional balance, were developed for general contraceptive and condom use. The second investigation was a measurement study conducted in collaboration with the Centers for Disease Control and Prevention (CDC), and consisted of 238 impoverished women at high risk for HIV infection or transmission. Measures and models for specific methods of contraception were developed for the stages of change, decisional balance, self-efficacy, and the processes of change for condom use. Lastly, the third sample involved college-age men and women ili = 248) which cross-validated the measures developed with high risk women. A measure for the processes of change for birth control use was included, as well as several additional measures sexual assertiveness, perceived risk, sexual abuse. Overall, the findings support the applicability of the Transtheoretical Model to contraceptive and condom use behavior across alternative samples. The major findings include: a general measure could be employed when examining hormonal methods of birth control, whereas condom use needs to be model separately with main and other partners; both populations were further along in the stages for pregnancy prevention, as compared with disease prevention; individuals were further along for using condoms with casual partners, as compared with main partners; individuals in the precontemplation stage had significantly lower pros scores for both pregnancy and disease prevention the opposite was true for those in the maintenance stage; the pros and cons cross-over occurred in either contemplation or preparation; self-efficacy is the lowest in the precontemplation stage and continues to climb with further movement through the stages; the construct of sexual assertiveness provided unique information regarding condom use; two measures assessing the processes of change (general birth control/condom use) demonstrated that experiential processes peaked in the preparation stage and the use of the behavioral processes (e.g. stimulus control) continued to climb into the maintenance stage; and, although men and women did not differ on current use or intention to use contraceptives/condoms, distinct sex differences were found for the other model constructs and sexual assertiveness. ACKNOWLEDGEMENTS I would like to acknowledge several individuals for their support. I thank the people who served on my dissertation committee: Dr. 's Wayne Velicer, Richard Gelles, and Cynthia Willey. Special thanks are sent to my long time friend and confidant, Dr. Joel Cohen, who served on both my Master's and Dissertation committees. Joel believed in me long before I believed in myself. A special thanks goes to Dr. Lisa L. Harlow who has, frankly, taught me just about everything I know about statistics from setting up data files to interpreting large multivariate solutions. I am strongly indebted to her patience and guidance. I would also like to thank my collaborator and dear friend, Gabrielle E. Riley. I marvel at her maturity and insight into human behavior. I will treasure the hours we spent together "brain-storming" items, running analyses, going to professional meetings, as well as laughing and crying together. Never again shall I have such a fulfilling experience . How do I express the appreciation and love that I hold for my major professor, James 0. Prochaska? Dr. Prochaska has given me both the challenges and the freedom to explore areas most individuals at my level could not comprehend. His vision of the future, as well as his strong belief in me and my abilities, have given me the courage to become the kind of person I was always meant to be. Finally, I would like to express my love and appreciation to my family: my son, Jim; my daughter, Heather; my grand-daughter, Natasha; and, especially my husband, Jim. Without your support I could never have "realized" my dream.