Research questions and study rationale
The rationale for conducting the study was to use the Trans-theoretical model to examine the factors that are associated with the movement by high-risk adolescents towards or away from engaging inconsistent condom use behavior. The study aimed at narrowing the literature gap that exists among longitudinal studies of the process of change among adolescents (Grossman et al., 2008).
The trans-theoretical model and its application to the study
The Trans-theoretical model describes the stages of change and tries to explain why and how individuals change and the change process can be predicted and maintained. This model is used to categorize individuals on their basis of adoption of safe behaviors across different health domains such as smoking, condom use, and exercise. The model classifies individuals into five distinct stages, namely: pre-contemplation, contemplation, preparation, action, and maintenance. In the first three stages, the individual considers the adoption of the behavior but does not consistently engage in the behavior. In the last two stages, the individual is consistently engaging in the behavior with the intention of sustaining the behavior. The adoption of safer behavior is marked by self-efficacy and decisional balance (Grossman et al., 2008).
The Trans-theoretical model has been applied to this study. Although no question has been stated in the study, the aim of the study was to assess the process of change among adolescents with regard to the use of condoms. The researchers argue that the adoption of condom use is not an individual decision but rather it requires communication and discussions with one’s partner. The dependent variable was the stage of change.
The stage of change was assessed by the frequency of condom use in the past 3 months. The independent variables were categorized into sexual attitude and substance use. Under sexual attitude, the researchers used four variables, namely: pros of condom use, cons of condom use, peer norms, condom use communication and negotiation, and perceived invulnerability. Substance use was assessed by the frequency with which the participants had used alcohol and marijuana. In addition, the demographic variables of the participants were also collected (Grossman et al., 2008).
Discussion of the study
To begin with, the researchers classified the adolescents who were not using condoms during the majority of their sexual activity as Inconsistent Condom Users. These were the participants who were in the first three stages of change. Additionally, those participants who moved toward more consistent condom use during follow-up were categorized as Progressors while those who remained in the same stage were categorized as Nonprogressors. On the other hand, those participants who were in the two later stages were classified as Consistent Condom Users. These participants were further categorized as Maintainers if they continued to use condoms consistently, and Relapsers, if they reported fewer intentions of condom use (Grossman et al., 2008).
The majority of the participants (64 percent) were actually Inconsistent Condom Users, implying that they were in the first three stages: pre-contemplation, contemplation, and preparation stages. The implication for this finding is that although these participants engaged in sexual activities, their use of condoms was very low because of negative attitudes towards condom use as well as greater perceptions of themselves as invulnerable to HIV (Grossman et al., 2008).
Limitations and conclusions of the study
One of the limitations of the study is that it did not include all variables that might be associated with the Stage of Change Model, for instance, self-efficacy for condom use. The researchers also argue there was a need to use 3 months rather than the 6-month interval to categorize participants in the maintenance stage. The study also cannot be generalized to younger adolescents who are in their early stages of engaging in sexual activity.
This is because the mean age of the sample used in the study was 18. The generalizability of the study was further limited by the voluntary nature of the recruitment strategy used. The researchers concluded that positive attitudes and communication about condom use have a strong impact on the adoption of safer sexual behavior. As a result, interventions that aim at improving such attitudes and communication are more likely to have a great impact when it comes to promoting condom use among adolescents (Grossman et al., 2008).
Alternative theoretical model
If the purpose of another study was to predict condom use in a certain population, the Planned Behavior model would be used. This model puts great emphasis on the effect of subjective norms, including peer norms, on behavioral change (Courneya, Plotnikoff, Hotz & Birkett, 2001). The predictors in this study would include gender, the extent of social cohesion, frequency of use of social network sites such as Facebook, and knowledge about the risks of unprotected sex.
Proposal for an HIV/AIDS study using the PRECEDE-PROCEED Model
The PRECEDE-PROCEED model will be used to study the sexual behavior of long-distance truck drivers, given that there is evidence of increasing HIV/AIDS rates among members of this population (Green & Kreuter, 1999). The rationale for conducting this study would be to change the sexual behaviors of long-distance truck drivers from risky behaviors to safer ones. To begin with, the participants will be randomly selected.
The design will involve conducting in-depth interviews with the selected individuals. The interview will include issues such as: how often they engage in sexual activities on any given week; their sexual partners, that is, whether they have regular or irregular sexual partners; whether or not they use condoms during their sexual encounters; whether or not they go for regular testing of their HIV statuses, and the reasons behind their risky sexual behaviors. In addition, data on the marital status of the participants will be collected because such a risky behavior would definitely have an adverse effect on their marital partners. Components of the study would include:
- Defining the final result – the desired outcome is to ensure that the long-distance truck drivers adopt safer sexual behaviors.
- Issue identification – the issue that would most likely affect the outcome mentioned is the lack of access to condoms by the drivers during their journeys
- Examination of the factors that may influence behavior – the major factor that may influence the behavior of these drivers is drug use such as alcohol most especially when the drivers are taking their rest. Knowledge of the association between alcohol use and irresponsible behavior is therefore likely to reduce the tendency of the drivers to engage in risky behaviors. Availability of condoms, on the other hand, is an enabling factor to behavior change.
- Identification of best practice – the best practice would be to engage the drivers in a regular mass education program about HIV/AIDS and how they can protect themselves from it.
- Outcome assessment – the evaluation of the outcomes of the intervention program would be done through interviews, six months after the implementation of the program. The outcomes would be measured by: the change in the number of sexual partners the drivers have, and the change in the use of condoms.
Courneya, K. S., Plotnikoff, R. C., Hotz, S. B., & Birkett, N. J. (2001). Predicting exercise stage transitions over two consecutive 6-month periods: A test of the theory of planned behaviour in a population-based sample. British Journal of Health Psychology, 6, 135–150.
Green, L. W., & Kreuter, M. (1999). Health Promotion and Planning: An Educational and Environmental Approach. Mountain View, CA: Mayfield Publishing Co.
Grossman, C., Hadley, W., Brown, L.K., Houck, C.D., Peters, A., & Tolou-Shams, M. (2008). Adolescent sexual risk: Factors predicting condom use across the stages of change. AIDS Behavior, 12, 913-922.