This article was downloaded by: [University of Sussex Library] On: 01 February 2015, At: 17:50 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probation/remand homes a
a
D. J. Wilson , S. Lavelle & R. Hood
a
a
University of Zimbabwe , Zimbabwe Published online: 25 Sep 2007.
To cite this article: D. J. Wilson , S. Lavelle & R. Hood (1990) Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probation/remand homes, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2:3, 267-274, DOI: 10.1080/09540129008257739 To link to this article: http://dx.doi.org/10.1080/09540129008257739
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 2, NO.3,1990
267
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probationhemand homes D. J. WILSON,S. LAVELLE & R. HOOD University of Zimbabwe, Zimbabwe
Abstract The association of AIDS knowledge, perceived susceptibility to HI& eflcacy of preventive measures, severity of HIV infection, cues to action, bam'ers to action and alcohol/drug use with intended condom use was examined among Zimbabwean adolescents (mean age= 16.9) in probatiodremand homes. Eighty-six percent of males and 83% offemales were reportedly sexually experienced of whom 28% of males and 14% of females reported consistent condom use. Those who knew that babies can be born with AIDS, that there is no vaccine against HIV and that traditional healers cannot cure AIDS were 2.50, 2.32 and 1.97 times as likely to definitely intend to use condoms. Individuals who believed condoms seldom break or leak and are effective against HIV were 4.12 and 4.65 times as likely to definitely intend to use them. Those who believed parents and boyfiend/@rlfiends thought condoms should be used were 2.27 and 2.13 times as likely to intend to use them. Respondents echo had talked about AIDS with friends, with their boyy%tend/girlfnendor a schoolteacher or seen a picture or film of a PWA were, in comparison to those who had not engaged in these actions, 3.70, 2.33, 2.43 and 2.50 times as likely to definitely intend to use condoms. Those who were embarrassed to get condoms from a clinic, thought persons who use condoms are loose and or that the pleasure of unprotected sex was worth the risk of HIV were 3.87, 3.42 and 3.40 times as likely to intend to use condoms. Logistic regression identified belitfin ejicacy of condoms as the principal predictor of intended condom use. The implications of these results for AIDS education are discussed. Introduction
AIDS has affected central Africa more than any other region (Biggar, 1986; Dickson, 1987; Mann et al., 1988; Quinn, 1987; Ronald et al., 1988). In central Africa, as elsewhere, there is an urgent need to identify factors that motivate HIV-preventive behaviour and to improve AIDS education by emphasising these factors. The Health Belief Model (HBM), which has shown utility in predicting health behaviours as &verse as weight loss, smoking cessation and seat belt use (Jan2 & Becker, 1984), has recently been applied to HIV-preventive behaviour (Becker & Joseph, 1988). In amplified form, it premises that individuals will adapt HIV-
Address for correspondence: D. Wilson, Psychology Department, University of Zunbabwe, PO Box MP 167, Mount Pleasant, Harare, Zimbabwe.
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
268 D. J. WILSON E T A . prevention measures if they have infomation about AIDS, believe that they are susceptible to HIV infection, that the consequences of HIV infection are severe, that preventive steps are eflectiwe, that there is concerted social support for preventive measures, experience cues to action and perceive few bam'ers to action. Emmons et al., 1986) reported that AIDS knowledge, perceived susceptibility, perceived efficacy of preventive behaviour, barriers to action and perceived social norms predicted preventive practices among 909 homosexuals in Chicago. Eksvand et 41. (1989) and Galvoni et al. (1989) also found health beliefs to be useful in predicting HIV-preventive practices among gaylbisexual North Americans. In a survey of 1072 random-digit-dialled adults in Montreal, Allard (1989) reported that beliefs concerning personal susceptibility to, the severity of, and the preventability of, AIDS, predicted HIV-preventive measures. Among 1,773 random-digit-dialled Massachussets adolescents, Hingson et al. (1989) found that perceptions concerning susceptibility to HIV and the efficacy of condoms, exposure to cues to action and the absence of barriers to action predicted condom use. Alcoholldrug use may also promote HIV-risk practices (Molgard et al., 1988; Hingson et ul., 1989). This study examined health beliefs, alcoholldrug use and intended condom use among adolscents in probationlremand homes in Zimbabwe, central Africa. Adolescents in probationlremand institutions were chosen because they may be at especially high risk for HIV infection (Temoshok et al., 1989). Methods
Respondents were 196 (156 male, 33 female, 7 undisclosed) adolescents (mean age=16.9, SD = 1.8, 95% CI = 16.6, 17.1). All adolescents from all five Zimbabwean probationlremand homes admitting adolescents aged approximately 14 years and above were asked to volunteer to complete an anonymous questionnaire: an entire population was thus surveyed. Seven children did not participate because they were educationally disadvantaged. The most common offences committed were petty theft, repeated truancy and substance use. Traceable personal descriptors were limited to sex and age to maximise anonymity. AIDS prevention counselling was provided after the questionnaires were collected. The questionnaire, whose items are summarised in Table 1, was developed as follows: First, major content areas were derived. Second, Euro-American (Allard, 1989; DiClemente et al., 1986; Emmons et al., 1986; Strunin & Hingson, 1987; Hingson et al., 1989; Temoshok et al., 1989; Temoshok et al., 1987; Traeen et al., 1989) and Zimbabwean (Pritts et al., 1989; Wilson et al., 1989a; Wilson et al., 1989b; Wilson et al., 1989c; Wilson et al., 1989; Wilson et al., 1990; Wilson et ul., & Wilson, 1989e; Wilson & Wilson, 1987) KAP and health belief inventories were inspected to help develop and refine items. Third, items were revised on the basis of extensive pilot research with health belief schedules (Wilson et al., 1989d; Wilson er al., 1990).
Results Sex behaviout
Eighty-six percent of males and 83% of females reported having sexual intercourse, of whom 28% of males and 14% of females reported consistent condom use during coitus. Male and female mean estimates of their age at first coitus were 17.6 (SD=2.7) and 16.5 (SD=9.8) years, respectively. Male and female estimates of their partner's age at first coitus were 14.9 (SD =4.6) and 18.4 (SD= 3.9), respectively. Forty-five percent of sexually experienced males reported coitus with a prostitute.
HEALTH BELIEFS AND CONDOM USE IN ZIMBABWE
Table 1. Questions on individual health belie> Individual health beliefs
Knowledge Have you ever heard about AIDS? Can a penon get AIDS from sexual intercourse? Can a person get AIDS from a healthy looking person? Can babies be
born with AIDS?
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
Does the use of a condom during sexual intercourse reduce the risk of getting AIDS? Are people who wash carefully after sex safe from AIDS? Can traditional healers cure AIDS?
Is there a vaccine for AIDS? SulupIibiliIy What risk do you think there is of you getting AIDS? kcriry Is a person who has AIDS likely to die from the disease?
Is AIDS usually a painful
~ISCPS~?
Effectiveness I wouldn’t use condoms because they break or leak
I wouldn’t use condoms because they aren’t effective against AIDS social suppon My friends think that condoms should be used during sex My boyfriend/girlfriend t h k s that condoms should be used during sex My parents thmk that condom should be used during sex CWS
Have you talked about AIDS with your friends? Have you talked about AIDS with your boyfriend/girlfriend? Have you talked about AIDS with a doctor or nurse? Have you talked about AIDS with a schoolteacher? Have you seen a picture or Iilm of someone who is sick with AIDS?
Barrim I don’t know what a condom is
I would be embarrassed to discuss condoms with my sexual partner I would be c m b d to get condoms from a shop or clinic
I wouldn’t know where or how to get condoms I wouldn’t know how to use condoms properly Sex is so much better without condoms that it is worth the risk of getting AIDS People who use condoms are sexually loose 1 wouldn’t insist on the ux of condoms because my sexual partner might thnk I had AIDS
269
270 D. J. WILSON E T A . Table 1. (Continued) Individual health beliefs Akohol/dmg use If you have had sexual intercourse, how often have you drunk alcohol before or during sexual intercourse?
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
If you have had sexual intercourse, how often have you used mbanje (marijuana) before or during sexual intercourse?
Descriptive data Responses for each p r d c t o r in Table 1 were analysed. There were sex differences on only three items: more males than females knew what a condom was, xZ (1)=6.09,p
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probation/remand homes a
a
D. J. Wilson , S. Lavelle & R. Hood
a
a
University of Zimbabwe , Zimbabwe Published online: 25 Sep 2007.
To cite this article: D. J. Wilson , S. Lavelle & R. Hood (1990) Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probation/remand homes, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2:3, 267-274, DOI: 10.1080/09540129008257739 To link to this article: http://dx.doi.org/10.1080/09540129008257739
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 2, NO.3,1990
267
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probationhemand homes D. J. WILSON,S. LAVELLE & R. HOOD University of Zimbabwe, Zimbabwe
Abstract The association of AIDS knowledge, perceived susceptibility to HI& eflcacy of preventive measures, severity of HIV infection, cues to action, bam'ers to action and alcohol/drug use with intended condom use was examined among Zimbabwean adolescents (mean age= 16.9) in probatiodremand homes. Eighty-six percent of males and 83% offemales were reportedly sexually experienced of whom 28% of males and 14% of females reported consistent condom use. Those who knew that babies can be born with AIDS, that there is no vaccine against HIV and that traditional healers cannot cure AIDS were 2.50, 2.32 and 1.97 times as likely to definitely intend to use condoms. Individuals who believed condoms seldom break or leak and are effective against HIV were 4.12 and 4.65 times as likely to definitely intend to use them. Those who believed parents and boyfiend/@rlfiends thought condoms should be used were 2.27 and 2.13 times as likely to intend to use them. Respondents echo had talked about AIDS with friends, with their boyy%tend/girlfnendor a schoolteacher or seen a picture or film of a PWA were, in comparison to those who had not engaged in these actions, 3.70, 2.33, 2.43 and 2.50 times as likely to definitely intend to use condoms. Those who were embarrassed to get condoms from a clinic, thought persons who use condoms are loose and or that the pleasure of unprotected sex was worth the risk of HIV were 3.87, 3.42 and 3.40 times as likely to intend to use condoms. Logistic regression identified belitfin ejicacy of condoms as the principal predictor of intended condom use. The implications of these results for AIDS education are discussed. Introduction
AIDS has affected central Africa more than any other region (Biggar, 1986; Dickson, 1987; Mann et al., 1988; Quinn, 1987; Ronald et al., 1988). In central Africa, as elsewhere, there is an urgent need to identify factors that motivate HIV-preventive behaviour and to improve AIDS education by emphasising these factors. The Health Belief Model (HBM), which has shown utility in predicting health behaviours as &verse as weight loss, smoking cessation and seat belt use (Jan2 & Becker, 1984), has recently been applied to HIV-preventive behaviour (Becker & Joseph, 1988). In amplified form, it premises that individuals will adapt HIV-
Address for correspondence: D. Wilson, Psychology Department, University of Zunbabwe, PO Box MP 167, Mount Pleasant, Harare, Zimbabwe.
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
268 D. J. WILSON E T A . prevention measures if they have infomation about AIDS, believe that they are susceptible to HIV infection, that the consequences of HIV infection are severe, that preventive steps are eflectiwe, that there is concerted social support for preventive measures, experience cues to action and perceive few bam'ers to action. Emmons et al., 1986) reported that AIDS knowledge, perceived susceptibility, perceived efficacy of preventive behaviour, barriers to action and perceived social norms predicted preventive practices among 909 homosexuals in Chicago. Eksvand et 41. (1989) and Galvoni et al. (1989) also found health beliefs to be useful in predicting HIV-preventive practices among gaylbisexual North Americans. In a survey of 1072 random-digit-dialled adults in Montreal, Allard (1989) reported that beliefs concerning personal susceptibility to, the severity of, and the preventability of, AIDS, predicted HIV-preventive measures. Among 1,773 random-digit-dialled Massachussets adolescents, Hingson et al. (1989) found that perceptions concerning susceptibility to HIV and the efficacy of condoms, exposure to cues to action and the absence of barriers to action predicted condom use. Alcoholldrug use may also promote HIV-risk practices (Molgard et al., 1988; Hingson et ul., 1989). This study examined health beliefs, alcoholldrug use and intended condom use among adolscents in probationlremand homes in Zimbabwe, central Africa. Adolescents in probationlremand institutions were chosen because they may be at especially high risk for HIV infection (Temoshok et al., 1989). Methods
Respondents were 196 (156 male, 33 female, 7 undisclosed) adolescents (mean age=16.9, SD = 1.8, 95% CI = 16.6, 17.1). All adolescents from all five Zimbabwean probationlremand homes admitting adolescents aged approximately 14 years and above were asked to volunteer to complete an anonymous questionnaire: an entire population was thus surveyed. Seven children did not participate because they were educationally disadvantaged. The most common offences committed were petty theft, repeated truancy and substance use. Traceable personal descriptors were limited to sex and age to maximise anonymity. AIDS prevention counselling was provided after the questionnaires were collected. The questionnaire, whose items are summarised in Table 1, was developed as follows: First, major content areas were derived. Second, Euro-American (Allard, 1989; DiClemente et al., 1986; Emmons et al., 1986; Strunin & Hingson, 1987; Hingson et al., 1989; Temoshok et al., 1989; Temoshok et al., 1987; Traeen et al., 1989) and Zimbabwean (Pritts et al., 1989; Wilson et al., 1989a; Wilson et al., 1989b; Wilson et al., 1989c; Wilson et al., 1989; Wilson et al., 1990; Wilson et ul., & Wilson, 1989e; Wilson & Wilson, 1987) KAP and health belief inventories were inspected to help develop and refine items. Third, items were revised on the basis of extensive pilot research with health belief schedules (Wilson et al., 1989d; Wilson er al., 1990).
Results Sex behaviout
Eighty-six percent of males and 83% of females reported having sexual intercourse, of whom 28% of males and 14% of females reported consistent condom use during coitus. Male and female mean estimates of their age at first coitus were 17.6 (SD=2.7) and 16.5 (SD=9.8) years, respectively. Male and female estimates of their partner's age at first coitus were 14.9 (SD =4.6) and 18.4 (SD= 3.9), respectively. Forty-five percent of sexually experienced males reported coitus with a prostitute.
HEALTH BELIEFS AND CONDOM USE IN ZIMBABWE
Table 1. Questions on individual health belie> Individual health beliefs
Knowledge Have you ever heard about AIDS? Can a penon get AIDS from sexual intercourse? Can a person get AIDS from a healthy looking person? Can babies be
born with AIDS?
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
Does the use of a condom during sexual intercourse reduce the risk of getting AIDS? Are people who wash carefully after sex safe from AIDS? Can traditional healers cure AIDS?
Is there a vaccine for AIDS? SulupIibiliIy What risk do you think there is of you getting AIDS? kcriry Is a person who has AIDS likely to die from the disease?
Is AIDS usually a painful
~ISCPS~?
Effectiveness I wouldn’t use condoms because they break or leak
I wouldn’t use condoms because they aren’t effective against AIDS social suppon My friends think that condoms should be used during sex My boyfriend/girlfriend t h k s that condoms should be used during sex My parents thmk that condom should be used during sex CWS
Have you talked about AIDS with your friends? Have you talked about AIDS with your boyfriend/girlfriend? Have you talked about AIDS with a doctor or nurse? Have you talked about AIDS with a schoolteacher? Have you seen a picture or Iilm of someone who is sick with AIDS?
Barrim I don’t know what a condom is
I would be embarrassed to discuss condoms with my sexual partner I would be c m b d to get condoms from a shop or clinic
I wouldn’t know where or how to get condoms I wouldn’t know how to use condoms properly Sex is so much better without condoms that it is worth the risk of getting AIDS People who use condoms are sexually loose 1 wouldn’t insist on the ux of condoms because my sexual partner might thnk I had AIDS
269
270 D. J. WILSON E T A . Table 1. (Continued) Individual health beliefs Akohol/dmg use If you have had sexual intercourse, how often have you drunk alcohol before or during sexual intercourse?
Downloaded by [University of Sussex Library] at 17:50 01 February 2015
If you have had sexual intercourse, how often have you used mbanje (marijuana) before or during sexual intercourse?
Descriptive data Responses for each p r d c t o r in Table 1 were analysed. There were sex differences on only three items: more males than females knew what a condom was, xZ (1)=6.09,p
