Mediation effect of perceived behavioural control on intended condom use: applicability of the theory of planned behaviour to money boys in China
Hongjie Liu A F , May Kennedy B , Hui Liu C , Fuchang Hong D , Toan Ha A and Zheng Ning E
+ Author Affiliations
- Author Affiliations
A Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20740, USA.
B Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
C China Center for HIV/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, China.
D Department of HIV/STD Control and Prevention, Shenzhen Center for Chronic Disease Control and Prevention, Shenzhen 518020, China.
E Department of HIV/STD Control and Prevention, Shanghai Center for Chronic Disease Control and Prevention, Shanghai 200336, China.
F Corresponding author. Email: hliu1210@umd.edu
Sexual Health 10(6) 487-494 https://doi.org/10.1071/SH13028
Submitted: 6 May 2012 Accepted: 1 August 2013 Published: 11 October 2013
Abstract
Background: Money boys (MBs) are male sex workers who sell sex to men who have sex with men. The objectives of this study were to assess (a) the sexual HIV risk of MBs; (b) the ability of the theory of planned behaviour (TPB) to predict MBs’ intentions to use condoms; and (c) the manner in which TPB constructs (attitudes towards condom use, subjective norms and perceived behavioural control) combine to influence condom use intentions. Methods: Participants came from 10 MB-frequented clubs in two cities in China. Multiple regression and path analytic models were used to test inter-relationships among the TPB constructs. Results: Seventy-eight percent of the 122 MB participants reported having used condoms for every anal sex act. About one-third reported having had female sexual partners in the past 2 months; of these MBs, half (53%) used condoms for every sex act. A revised model using TPB constructs accounted for 52% of the variance of condom use intentions and revealed that perceived behavioural control was a mediator in pathways beginning with attitudes and ending with condom use intentions, and beginning with subjective norms and ending with intentions. Conclusions: The findings suggest that a revised model of TPB applies to condom use intentions among Chinese MBs. It may be appropriate to adapt HIV interventions that are grounded in TPB and that have been shown to be effective elsewhere for use with Chinese MBs. HIV interventions for this population should give perceived behavioural control and its predictors special consideration.
Additional keywords: male sex worker, men who have sex with men, path analytic models.
References
[1] Sun X, Lu F, Wu Z, Poundstone K, Zeng G, Xu P, et al Evolution of information-driven HIV/AIDS policies in China. Int J Epidemiol 2010; 39 ii4–13.| Evolution of information-driven HIV/AIDS policies in China.Crossref | GoogleScholarGoogle Scholar | 21113036PubMed |
[2] Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China’s response to HIV/AIDS. Lancet 2007; 369 679–90.
| Evolution of China’s response to HIV/AIDS.Crossref | GoogleScholarGoogle Scholar | 17321313PubMed |
[3] Zhang X, Miège P, Zhang Y. Decentralization of the provision of health services to people living with HIV/AIDS in rural China: the case of three counties. Health Res Policy Syst 2011; 9 9
| Decentralization of the provision of health services to people living with HIV/AIDS in rural China: the case of three counties.Crossref | GoogleScholarGoogle Scholar | 21310093PubMed |
[4] Ma X, Zhang Q, He X, et al Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. J Acquir Immune Defic Syndr 2007; 45 581–7.
| Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006.Crossref | GoogleScholarGoogle Scholar | 17577125PubMed |
[5] Liu H, Liu H, Cai Y, Rhodes AG, Feng F. Money boys, level of HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China. AIDS Behav 2009; 13 652–62.
| Money boys, level of HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China.Crossref | GoogleScholarGoogle Scholar | 18841459PubMed |
[6] Parker R, Aggleton P. HIV and AIDS related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 2003; 57 13–24.
| HIV and AIDS related stigma and discrimination: a conceptual framework and implications for action.Crossref | GoogleScholarGoogle Scholar | 12753813PubMed |
[7] Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med 2007; 4 e339
| Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review.Crossref | GoogleScholarGoogle Scholar | 18052602PubMed |
[8] Liu H, Feng T, Ha T, et al Chinese culture, homosexuality stigma, social support and condom use: a path analytic model. Stigma Res Action 2011; 1 27–35.
| 1:CAS:528:DC%2BC38Xpt1Ggt78%3D&md5=1102bec3b2c62946454f001b2a5f1952CAS | 21731850PubMed |
[9] Wong FY, Huang ZJ, He N, et al HIV risks among gay- and non-gay-identified migrant money boys in Shanghai, China. AIDS Care 2008; 20 170–80.
| HIV risks among gay- and non-gay-identified migrant money boys in Shanghai, China.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c7jtlSruw%3D%3D&md5=307a01073dab22b9ed3ad6e1c5587886CAS | 18293125PubMed |
[10] Liu S, Chen L, Zhao J, et al Condom use with various types of sex partners by money boys in China. AIDS Educ Prev 2012; 24 163–78.
| Condom use with various types of sex partners by money boys in China.Crossref | GoogleScholarGoogle Scholar | 22468976PubMed |
[11] He N, Wong FY, Huang ZJ, et al Hiv risks among two types of male migrants in Shanghai, China: money boys vs. general male migrants. AIDS 2007; 21 S73–9.
| Hiv risks among two types of male migrants in Shanghai, China: money boys vs. general male migrants.Crossref | GoogleScholarGoogle Scholar | 18172395PubMed |
[12] Tao X, Gai R, Zhang N, et al HIV infection and mental health of “money boys”: a pilot study in Shandong Province, China. Southeast Asian J Trop Med Public Health 2010; 41 358–68.
| 20578519PubMed |
[13] Auerbach JD, Parkhurst JO, Caceres CF. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Glob Public Health 2011; 6 S293–309.
| Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations.Crossref | GoogleScholarGoogle Scholar | 21745027PubMed |
[14] World Health Organization (WhO). Global health sector strategy on HIV/AIDS for 2011–2015. Geneva: WHO; 2011. Available online at: http://whqlibdoc.who.int/publications/2011/9789241501651_eng.pdf [verified September 2012].
[15] Johnson WD, Diaz RM, Flanders WD, et al Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Data Syst Rev 2008; 16 CD001230
[16] Herbst JH, Sherba RT, Crepaz N, et al A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men for reducing sexual risk behavior. J Acquir Immune Defic Syndr 2005; 39 228–41.
| 15905741PubMed |
[17] Ota E, Wariki WMV, Mori R, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries. Cochrane Database Syst Rev 2011; CD006045
| Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries.Crossref | GoogleScholarGoogle Scholar | 22161397PubMed |
[18] Liu H, Yang H, Li X, et al Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sex Transm Dis 2006; 33 68–76.
| Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China.Crossref | GoogleScholarGoogle Scholar | 16432476PubMed |
[19] Wong FY, Huang ZJ, Wang W, et al STIs and HIV among men having sex with men in China: a ticking time bomb? AIDS Educ Prev 2009; 21 430–46.
| STIs and HIV among men having sex with men in China: a ticking time bomb?Crossref | GoogleScholarGoogle Scholar | 19842827PubMed |
[20] National Institute of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial Group Results of the NIMH collaborative HIV/sexually transmitted disease prevention trial of a community popular opinion leader intervention. J Acquir Immune Defic Syndr 2010; 54 204–14.
| 20354444PubMed |
[21] Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991; 50 179–211.
| The theory of planned behavior.Crossref | GoogleScholarGoogle Scholar |
[22] Albarracín D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull 2001; 127 142–61.
| Theories of reasoned action and planned behavior as models of condom use: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 11271752PubMed |
[23] Wolfers M, Kok G, Looman C, de Zwart O, Mackenbach J. Promoting STI testing among senior vocational students in Rotterdam, the Netherlands: effects of a cluster randomized study. BMC Public Health 2011; 11 937
| Promoting STI testing among senior vocational students in Rotterdam, the Netherlands: effects of a cluster randomized study.Crossref | GoogleScholarGoogle Scholar | 22177021PubMed |
[24] Xiao Z, Palmgreen P, Zimmerman R, Noar S. Adapting and applying a multiple domain model of condom use to Chinese college students. AIDS Care 2010; 22 332–8.
| Adapting and applying a multiple domain model of condom use to Chinese college students.Crossref | GoogleScholarGoogle Scholar | 20390513PubMed |
[25] Gu J, Lau JT, Chen X, et al Using the theory of planned behavior to investigate condom use behaviors among female injecting drug users who are also sex workers in China. AIDS Care 2009; 21 967–75.
| Using the theory of planned behavior to investigate condom use behaviors among female injecting drug users who are also sex workers in China.Crossref | GoogleScholarGoogle Scholar | 20024752PubMed |
[26] O’Leary A, Jemmott JB, Jemmott LS, et al Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents. Ann Behav Med 2012; 44 181–91.
| Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents.Crossref | GoogleScholarGoogle Scholar | 22618963PubMed |
[27] MacKinnon DP. Introduction to statistical mediation analysis. Mahwah, NJ: Lawrence Erlbaum Associates; 2008.
[28] Yzer M. Perceived control moderates attitudinal and normative effects on intention: I’d like to, but I can’t, so I won’t. In Ajzen I, Hornik R, Albarracin D, editors. Prediction and change of behaviour: applying the reasoned action approach. Mahwah, NJ: Lawrence Erlbaum Associates; 2007. pp 111–27.
[29] Kidwell B, Jewell RD. The moderated influence of internal control: an examination across health-related behaviors. J Consum Psychol 2003; 13 377–86.
| The moderated influence of internal control: an examination across health-related behaviors.Crossref | GoogleScholarGoogle Scholar |
[30] McMillan B, Conner M. Applying an extended version of the theory of planned behavior to illicit drug use among students. J Appl Soc Psychol 2003; 33 1662–83.
| Applying an extended version of the theory of planned behavior to illicit drug use among students.Crossref | GoogleScholarGoogle Scholar |
[31] Umeh K, Patel R. Theory of planned behaviour and ecstasy use: an analysis of moderator-interactions. Br J Health Psychol 2004; 9 25–38.
| Theory of planned behaviour and ecstasy use: an analysis of moderator-interactions.Crossref | GoogleScholarGoogle Scholar | 15006199PubMed |
[32] Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol 2001; 40 471–99.
| Efficacy of the theory of planned behaviour: a meta-analytic review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FmvFWguw%3D%3D&md5=2fd65da268952295611e1f180b849ff7CAS | 11795063PubMed |
[33] Reinecke J, Schmidt P, Ajzen I. Application of the theory of planned behavior to adolescents’ condom use: a panel study. J Appl Soc Psychol 1996; 26 749–72.
| Application of the theory of planned behavior to adolescents’ condom use: a panel study.Crossref | GoogleScholarGoogle Scholar |
[34] Boileau C, Rashed S, Sylla M, Zunzunegui MV. Monitoring HIV risk and evaluating interventions among young people in urban West Africa: development and validation of an instrument. AIDS Educ Prev 2008; 20 203–19.
| Monitoring HIV risk and evaluating interventions among young people in urban West Africa: development and validation of an instrument.Crossref | GoogleScholarGoogle Scholar | 18558818PubMed |
[35] McLaws ML, Oldenburg B, Ross MW. Application of the theory of reasoned action to the measurement of condom use among gay men. In Terry DJ, Gallois C, McCamish M, editors. The theory of reasoned action: its application to AIDS-preventive behaviour. Tarrytown, NY: Pergamon; 1993. pp. 169–84.
[36] Ross MW, McLaws ML. Subjective norms about condoms are better predictors of use and intention to use than attitudes. Health Educ Res 1992; 7 335–9.
| Subjective norms about condoms are better predictors of use and intention to use than attitudes.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3sbgsVOltg%3D%3D&md5=f2e6175c0389ef74b283051a9ba74c7eCAS | 10148741PubMed |
[37] Hopkins E, Rietmeijer C. Exploring HIV serosorting as a preventive behavior among men who have sex with men, using a comprehensive approach to behavioral science theory. In Ajzen I, Albarracin D, Hornik R, editors. Prediction and change of health behavior: applying the reasoned action approach. Mahwah, NJ: Lawrence Erlbaum Associates; 2007. pp. 211–22.
[38] Godin G, Maticka-Tyndale E, Adrien A, Manson-Singer S. Cross-cultural testing of three social cognitive theories: an application to condom use. J Appl Soc Psychol 1996; 26 1556–86.
| Cross-cultural testing of three social cognitive theories: an application to condom use.Crossref | GoogleScholarGoogle Scholar |
[39] Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51 1173–82.
| The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2s7ht1SrsQ%3D%3D&md5=d3cb607a1d79a39b9a74f38f0f2ac812CAS | 3806354PubMed |
[40] Bryan A, Schmiege SJ, Broaddus MR. Mediational analysis in HIV/AIDS research: estimating multivariate path analytic models in a structural equation modeling framework. AIDS Behav 2007; 11 365–83.
| Mediational analysis in HIV/AIDS research: estimating multivariate path analytic models in a structural equation modeling framework.Crossref | GoogleScholarGoogle Scholar | 16917669PubMed |
[41] Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. New York: Psychology Press; 2010.
[42] Triandis HC, Bontempo R, Villareal MJ, Asai M, Lucca N. Individualism and collectivism: cross-cultural perspectives on selfngroup relationships. J Pers Soc Psychol 1988; 54 323–38.
| Individualism and collectivism: cross-cultural perspectives on selfngroup relationships.Crossref | GoogleScholarGoogle Scholar |
[43] Sampson J, Witte K, Morrison K, Liu W-Y, Hubbell AP, Murray-Johnson L. Addressing cultural orientation in fear appeals: promoting AIDS-protective behaviors among Mexican immigrant and African American adolescents and American and Taiwanese college students. J Health Commun 2001; 6 335–58.
| Addressing cultural orientation in fear appeals: promoting AIDS-protective behaviors among Mexican immigrant and African American adolescents and American and Taiwanese college students.Crossref | GoogleScholarGoogle Scholar | 11783667PubMed |
[44] Hui CH, Triandis HC. Individualism–collectivism: a study of cross-cultural researchers. J Cross Cult Psychol 1986; 17 225–48.
| Individualism–collectivism: a study of cross-cultural researchers.Crossref | GoogleScholarGoogle Scholar |
[45] Rotheram-Borus MJ, Li L, Liang LJ, Wen Y, Wu Z, NIMH Collaborative HIV/STD Prevention Trial Group Attitudinal, behavioral, and biological outcomes of a community popular opinion leader intervention in China. AIDS Educ Prev 2011; 23 448–56.
| Attitudinal, behavioral, and biological outcomes of a community popular opinion leader intervention in China.Crossref | GoogleScholarGoogle Scholar | 22010808PubMed |
[46] Triandis HC. Self and social behavior in differing cultural contexts. Psychol Rev 1989; 96 506–20.
| Self and social behavior in differing cultural contexts.Crossref | GoogleScholarGoogle Scholar |
[47] Rojanapithayakorn W. The 100% condom use programme in Asia. Reprod Health Matters 2006; 14 41–52.
| The 100% condom use programme in Asia.Crossref | GoogleScholarGoogle Scholar | 17101421PubMed |
[48] O’Leary A, Jemmott LS, Jemmott JB. Mediation analysis of an effective sexual risk-reduction intervention for women: the importance of self-efficacy. Health Psychol 2008; 27 S180–4.
| Mediation analysis of an effective sexual risk-reduction intervention for women: the importance of self-efficacy.Crossref | GoogleScholarGoogle Scholar | 18377160PubMed |
[49] Cáceres CF, Aggleton P, Galea JT. Sexual diversity, social inclusion and HIV/ AIDS. AIDS 2008; 22 S45–55.
| Sexual diversity, social inclusion and HIV/ AIDS.Crossref | GoogleScholarGoogle Scholar | 18641469PubMed |
[50] Kippax SC, Holt M, Friedman SR. Bridging the social and the biomedical: engaging the social and political sciences in HIV research. J Int AIDS Soc 2011; 14 S1–S3.
| Bridging the social and the biomedical: engaging the social and political sciences in HIV research.Crossref | GoogleScholarGoogle Scholar | 21968015PubMed |
[51] Logie C. The case for the World Health Organization’s Commission on the Social Determinants of Health to address sexual orientation. Am J Public Health 2012; 102 1243–6.
| The case for the World Health Organization’s Commission on the Social Determinants of Health to address sexual orientation.Crossref | GoogleScholarGoogle Scholar | 22594723PubMed |
[52] Mahajan A, Sayles J, Patel V, et al Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS 2008; 22 S67–79.
| Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward.Crossref | GoogleScholarGoogle Scholar | 18641472PubMed |
