Extending the Purview of the Risk Perception Attitude Framework: Findings from HIV/AIDS Prevention Research in Malawi

Abstract

The risk perception attitude (RPA) framework posits that efficacy beliefs moderate the relationship between risk perception and health outcomes. To extend the purview of the theory, this central hypothesis was tested in the context of HIV/AIDS-prevention behaviors. Data (N = 890) were collected from 8 districts in Malawi in southern Africa as part of a baseline research effort to obtain benchmark measures on key behavior-change indicators. Results pertaining to 2 behaviors, use of condoms and remaining monogamous, are reported in this study. Relationships between risk perception and behavioral intentions were not significant, but those between efficacy beliefs and behavioral intentions were. Furthermore, efficacy beliefs were found to moderate the relationship between risk perception and intentions to remain monogamous, but not between risk perceptions and intentions to use condoms. The model was able to explain approximately 40% of the variance in intentions to use condoms, and 19% of the variance in intentions to remain monogamous. Implications for health campaigns, particularly the need to strengthen efficacy beliefs and the need to be careful in enhancing risk perceptions without simultaneously strengthening efficacy beliefs, are also discussed.

Addressing the Slow Uptake of HIV Testing in Malawi: The Role of Stigma, Self-efficacy, and Knowledge in the Malawi BRIDGE Project

“…Female gender was especially associated with lower levels of self-efficacy, and overall efficacy beliefs were only moderate in strength, leaving considerable room for improvement. Furthermore, lack of self-efficacy and internal control over HIV emerged as a major theme during additional qualitative research (Rimal et al, 2004(Rimal et al, , 2009). …”

“…These included acts, such as talking with children, keeping a condom handy, talking to one's partner about use of condoms, and setting career goals. The project is described in Table 1, as well as in the study of Rimal et al (2006Rimal et al ( , 2008Rimal et al ( , 2009). …”

“…The survey instruments were based on previous surveys conducted by the research team and included questions derived from measures used by demographic and health surveys and other published work (MEASURE DHS, n.d.; Rimal et al, 2008Rimal et al, , 2009). The questionnaires were first translated into Chichewa and Tumbuka and then translated back into English.…”

“…The Malawi BRIDGE Project (Rimal, Böse, Brown, Mkandawire, & Folda, 2009;Rimal et al, 2008), a communication-based behavior change program funded by the United States Agency for International Development, was designed to promote HIV prevention in eight districts of Malawi by addressing some of the most relevant psychosocial variables discussed earlier in the text.…”

“…An 8-item test at baseline (study 1), and a similar 7-item test at mid-term (study 2) were used to ascertain participants' confidence in their ability to enact different types of prevention behaviors. As described previously (Rimal et al, 2008(Rimal et al, , 2009), we measured the individuals' efficacy to remain abstinent if not in a relationship, to remain faithful to one's partner, and to discuss and insist on use of condoms. Responses were coded on a 5-point scale and were averaged into an index ranging from 1 (lowest self-efficacy) to 5 (highest self-efficacy).…”