The Transtheoretical Model Applied to Safer Sex Behavior Among University Students: A Cross-Sectional Investigation

Abstract

This study applied the transtheoretical model of behavior change to safer sex adoption in a cross-sectional sample of 352 college students. The transtheoretical model has received empirical support in other areas of health behavior change and has important implications for intervention development. Variables assessed include the stages of change, decisional balance, confidence, temptation, processes of change, perceived risk, perceived severity, social desirability, and behavioral variables. Where possible, the sample was split randomly to conduct exploratory and confirmatory analyses. The Pros and Cons of safer sex were best represented by a 4-factor model instead of the usual 2-factor model. The new factors described concerns for self and relationship in safer sex decision making. Confidence in safer sex and Temptation for unsafe sex both revealed 5 lower-order situational factors: sexual arousal, perceived low risk, negative affect, substance use, and partner pressure. Processes of safer sex adoption analyses revealed all ten hypothetical processes of change, and one less common process, interpersonal systems control. MANOVAs and discriminant function analyses examined stage and gender differences. Different subsets of variables (transtheoretical model, demographics, and health beliefs model) were entered into several discriminant function analyses in order to predict AIDS risk group. The combination which best predicted AIDS risk group included variables from all sources, supporting theoretical eclecticism. Finally, a large cross-sectional structural equations model was developed using all model-based constructs. These constructs were used to predict behavioral constructs, risky and safer sexual behavior, which were intercorrelated r = -.323. Reducing this large structural model to include only significant paths left 3 transtheoretical constructs accounting for nearly 31% of the variance in risky sexual behavior and 11% of the variance in safer sexual behavior. These three variables were: experiential processes, behavioral processes, and confidence in safer sex. Results support the application of the transtheoretical model to safer sex adoption, as well as supporting model-based predictions about construct relationships in this area, with specific content-related differences between safer sex and other problem areas emerging for each scale. These results have important implications for AIDS risk reduction intervention development.

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