An Integrated Model of Condom Use in Sub-Saharan African Youth: A Meta-Analysis

Abstract

Objective: We tested an integrated social cognitive model derived from multiple theories of the determinants of young peoples’ condom use in Sub-Saharan Africa. The model comprised seven social cognitive antecedents of condom use: Attitudes, norms, control, risk perceptions, barriers, intentions, and previous condom use. Methods: We conducted a systematic search of studies including effects between at least one model construct and intended or actual condom use in young people from sub-Saharan African countries. Fifty-five studies comprising 72 independent data sets were included and subjected to random-effects meta-analysis. Demographic and methodological variables were coded as moderators. Hypotheses of the integrated model were tested using meta-analytic structural equation modeling. Results: The meta-analysis revealed significant non-trivial sample-weighted correlations among most model constructs. Moderator analyses revealed differences in six correlations for studies that included a formative research component relative to studies that did not. There was little evidence of systematic moderation of relations among model constructs by other candidate moderators. Meta-analytic structural equation models revealed significant direct effects of attitudes, norms, and control on condom use intentions, and of intention, control, and barriers on condom use. Including past condom use increased explained variance in condom use intentions and behavior but did not attenuate model effects. There were also significant indirect effects of attitudes, norms, and control on condom use through intentions. Conclusions: Findings provide preliminary evidence to support the integrated condom use model in sub-Saharan African youth. The model provides guidance on potential targets for improving the effectiveness of condom promotion interventions.

Trait Self‐Control, Social Cognition Constructs, and Intentions: Correlational Evidence for Mediation and Moderation Effects in Diverse Health Behaviours

“…While most measures of the study constructs used across samples in the present study were almost identical, there were variations; for example, in Sample 1, we used measures of outcome evaluations and self‐efficacy, and in Sample 5 we used a measure of self‐discipline rather than trait self‐control. While these constructs demonstrate good convergence at the conceptual level (Hagger et al., ; Protogerou, Johnson, & Hagger, ), differences in measures still have the potential to contribute to error variance. Further direct replication of the effects tested in the current study using identical measures is advocated to verify their robustness.…”

“…However, good temporal correspondence between the social cognition and behaviour measures in the current studies (cf. Ajzen, ) and the fact that time lag does not tend to moderate relations in social cognition theories (Hagger et al., ; Protogerou et al., ; Rich et al., ) suggest that this may not be a major source of error variance.…”

The reasoned action approach applied to health behavior: Role of past behavior and tests of some key moderators using meta-analytic structural equation modeling

“…Past behavior typically exhibits large effects on future behavior, illustrating that behavior tends to have high temporal stability. In the context of social cognitive models, research has consistently shown that the inclusion of past behavior as a predictor of behavior alongside the theorydetermined constructs has four important effects: (a) past behavior predicts behavior; (b) it predicts the other social cognitive variables in the model, including intention; (c) it attenuates effects of the other social cognitive variables on intentions and behavior; and (d) it leads to a significant increase in the amount of variance in behavior accounted for by the model (Ajzen, 2002;Brown et al, 2017;Hagger et al, 2002;Hamilton et al, 2017;Norman & Cooper, 2011;Protogerou et al, 2018).…”

On nomological validity and auxiliary assumptions: The importance of simultaneously testing effects in social cognitive theories applied to health behavior and some guidelines

“…It represents a robust test in that it is derived from multiple replications and is corrected for artifacts that may have led to a researcher making an incorrect decision as to the acceptance or rejection of the network. The adoption of this analytic approach is on the rise (e.g., Yu et al, 2007;Carraro and Gaudreau, 2013;Hagger et al, , 2017Cheung and Hong, 2017;Credé et al, 2017;Protogerou et al, 2017). For example, Carraro and Gaudreau (2013) conducted a meta-analytic path analysis testing a nomological network in which variables representing planning for physical activity (action planning and coping planning) mediated the relation between intentions and physical activity participation.…”