No abstract

Project RESPECT was a multisite randomized trial comparing three clinic-based interventions' ability to increase condom use and prevent infection with HIV and sexually transmitted diseases. Because Project RESPECT had guiding concepts that determined the content of the sessions, the authors investigated how the intervention operated using these theoretical variables. Growth curve analysis and structural equation modeling estimated the correlation between intentions toward condom use and self-reports of condom use and isolated the treatment effects on mediating variables--attitudes, self-efficacy, and social norms--that predict intentions. The correlations between intentions and behavior exceeded .70 for both genders, justifying the emphasis on intentions. Project RESPECT was effective through changing attitudes and self-efficacy for females in both counseling interventions. For males, only enhanced counseling had significant effects on these two mediator variables.

Objectives:We studied the eVect of small monetary incentives and non-monetary incentives of similar value on enrolment and participation in clinic based HIV/STD prevention counselling. We examined incident STDs to try to assess whether participants oVered money may be less motivated to change risky behaviours than those oVered other incentives. Methods: Patients from five US STD clinics were invited to enrol in a multisession risk reduction counselling intervention and, based on their enrolment date, were oVered either $15 for each additional session or non-monetary incentives worth $15. The two incentive groups were compared on participants' enrolment, completion of intervention sessions, and new STDs over the 24 months after enrolment. Results: Of 648 patients oVered money, 198 (31%) enrolled compared with 160 (23%) of 696 patients oVered other incentives (p=0.002). Enrollees in the two incentive groups had similar baseline characteristics, including condom use. Of the 198 participants oVered money, 109 (55%) completed all sessions compared with 59 (37%) of the participants oVered other incentives (p <0.0001). Comparing those oVered money with those oVered other incentives STD rates were similar after 6, 12, and 24 months. Conclusions: Small monetary incentives enhanced enrolment and participation compared with other incentives of similar value. Regardless of incentive oVered, participants had similar post-enrolment STD rates, suggesting that the type of incentive does not adversely aVect motivation to change behaviour. Money may be useful in encouraging high risk individuals to participate in and complete counselling or other public health interventions. (Sex Transm Inf 1998;74:253-255)

To study the structure of beliefs about condom use outcomes, the authors derived and tested 4 psychosocial hypothetical models: (a) a 2-factor model of the personal and social outcomes of condom use; (b) a 2-factor model of the pros and cons of the behavior; (c) a 3-factor model (i.e., physical, self-evaluative, and social) of outcome expectancies; and (d) a thematic 4-factor model of the protection, self-concept, pleasure, and interaction implications of the behavior. All 4 models were studied with a confirmatory factor analysis approach in a multisite study of 4,638 participants, and the thematic solution was consistently the most plausible. Self-concept and pleasure were most strongly associated with attitudes toward using condoms, intentions to use condoms, and actual condom use, whereas protection and interaction generally had little influence.

According to the Stages of Change (SOC) model, behavioural change involves a process of movement from precontemplation (no intention to change), to contemplation (some intention to change, but no behaviour), to preparation (intention to change and early inconsistent behavioural attempts to change), to action (consistent behavioural performance for less than six months) and finally, to maintenance (consistent behavioural performance for six months or more). Moreover, it is argued that cognitive (e.g. attitude change) and action oriented (e.g. changing self-efficacy) strategies are differentially effective at different stages. In contrast, most other behavioural prediction and change models suggest that both cognitive and action oriented approaches are necessary to move people from precontemplation to contemplation (i.e. to develop intentions). This paper tests this and other differences between these two theoretical approaches. Among other findings, our data indicate that a combination of cognitive and action strategies may be the most effective way to target individuals who have no intention to change their behaviour.