Cleo Protogerou

Using meta-analytic path analysis to test theoretical predictions in health behavior: An illustration based on meta-analyses of the theory of planned behavior

OBJECTIVE Synthesizing research on social cognitive theories applied to health behavior is an important step in the development of an evidence base of psychological factors as targets for effective behavioral interventions. However, few meta-analyses of research on social cognitive theories in health contexts have conducted simultaneous tests of theoretically-stipulated pattern effects using path analysis. We argue that conducting path analyses of meta-analytic effects among constructs from social cognitive theories is important to test nomological validity, account for mediation effects, and evaluate unique effects of theory constructs independent of past behavior. We illustrate our points by conducting new analyses of two meta-analyses of a popular theory applied to health behaviors, the theory of planned behavior. METHOD We conducted meta-analytic path analyses of the theory in two behavioral contexts (alcohol and dietary behaviors) using data from the primary studies included in the original meta-analyses augmented to include intercorrelations among constructs and relations with past behavior missing from the original analysis. RESULTS Findings supported the nomological validity of the theory and its hypotheses for both behaviors, confirmed important model processes through mediation analysis, demonstrated the attenuating effect of past behavior on theory relations, and provided estimates of the unique effects of theory constructs independent of past behavior. CONCLUSIONS Our analysis illustrates the importance of conducting a simultaneous test of theory-stipulated effects in meta-analyses of social cognitive theories applied to health behavior. We recommend researchers adopt this analytic procedure when synthesizing evidence across primary tests of social cognitive theories in health.

Predictors of non-condom use intentions by university students in Britain and Greece: the impact of attitudes, time perspective, relationship status, and habit

Objective: This study investigated the impact of socio-cognitive factors (attitudes and norms), time perspective (TP), relationship status (RS), and past sexual behaviour on intended non-condom use in 104 Greek and 93 British university undergraduates. Method: Data were obtained by a self-report questionnaire. Data analysis included correlation, regression and ANOVA procedures. Results: Attitudes were the strongest predictors of non-condom use intentions for participants who had casual relationships or were single (i.e. unstable relationship context), and past behaviour was the strongest predictor of non-condom use intentions for those who perceived themselves to be in an exclusive relationship (i.e. stable relationship context). Past behaviour was the strongest predictorof intended non-condom use in relation to all the variables of this study. TP managed to predict non-condom use intentions and moderate the attitudes-intentions relationship. In terms of temporal influences, participants high in fatalistic TP were strongly inclined not to use condoms, irrespective of their attitudes, but TP did not differ as a function of culture. Conclusions: Our data revealed the value of considering the combined effects of relationship status, habit and attitudes, when investigating undergraduate non-condom use intentions and designing interventions. The construct of TP was introduced as a meaningful addition to sexual risk research.

Factors Underlying the Success of Behavioral HIV-Prevention Interventions for Adolescents: A Meta-Review

The purpose of this meta-review was to identify characteristics of successful HIV prevention interventions for adolescents based on quantitative (i.e., meta-analyses) and qualitative reviews published to date, and to inform intervention utilization and future development. To that end, we were guided by principles of triangulation. Searches of seven electronic bibliographic databases yielded five meta-analyses and six qualitative reviews that satisfied the selection criteria. Reviews were subjected to careful content analysis. All reviews reported that behavioral interventions had positive outcomes on at least one of the following outcomes: HIV-related knowledge, subjective cognitions and beliefs enabling safer sex, abstinence, delaying next sexual intercourse, decreasing number of sexual partners, and actual condom use. Four categories, suggesting factors more prominently linked to intervention success, emerged: behavior change techniques (e.g., cognitive-behavior and motivation enhancement skills training); recipient characteristics (e.g., age, vulnerability to contracting STIs/HIV); prominent design features (e.g., use of theory, formative research); and socio-ecological features (e.g., supportive school environment). Future interventions would benefit from conducting preliminary formative research in order to enable optimal implementation of all these factors.ResumenEl propósito de este meta-análisis fue identificar las características de las intervenciones de prevención del VIH con éxito para adolescentes basado en cuantitativos (es decir, los meta-análisis) y comentarios cualitativos publicados hasta la fecha, y que informe a la utilización de la intervención y el desarrollo futuro. Para ello, nos hemos guiado por los principios de la triangulación. Búsquedas de siete bases de datos bibliográficas electrónicas produjeron cinco meta-análisis y seis revisiones cualitativas que cumplieran los criterios de selección. Las críticas fueron sometidas a análisis de contenido con cuidado. Todas las opiniones informaron que las intervenciones conductuales tuvieron resultados positivos en al menos uno de los siguientes resultados: el conocimiento, las cogniciones y creencias subjetivas relacionadas con el VIH que permiten el sexo seguro, la abstinencia, el retraso a la próxima relación sexual, disminuyendo el número de parejas sexuales y el uso real del condón. Emergieron cuatro categorías que sugieren factores sobresalientes relacionados a la intervención exitosa: técnicas de cambios de comportamiento (por ejemplo, formación de habilidades, cognitivas—de comportamiento y de mejora de la motivación); características del participante (por ejemplo, la edad, la vulnerabilidad a contraer ITS/VIH); características de diseño importantes (por ejemplo, el uso de la teoría, la investigación formativa); y las características socio-ecológicos (por ejemplo, el medio ambiente escolar de apoyo). Futuras intervenciones se beneficiaran de llevar a cabo investigaciones formativas preliminares para poder implementar óptimamente todos estos factores.

The theory of planned behaviour as a framework for predicting sexual risk behaviour in sub-Saharan African youth: A critical review

Amongst the psychological theories that have been used to help understand why people have unprotected sex, the Theory of Planned Behaviour (TPB: Ajzen 1991) has earned a prominent position. This article is a critical review of 11 peer-reviewed studies conducted in sub-Saharan Africa during 2001 to 2009, which used the TPB as a model of predicting sexual risk behaviour in young people. All the studies revealed the predictive ability of the TPB in urban, rural, and traditional African settings, with R 2 coefficients ranging between 0.14 and 0.67. With data comparing favourably to those obtained in the international literature, these studies indicate that the TPB can be used to study sexual risk intentions and behaviour in sub-Saharan African youth, and question arguments against the theorys use in non-Western settings.

Factors shaping condom use among South African university students: a thematic analysis

This study aimed to investigate contextual influences on condom use by South African university students. Twenty one-to-one, semi-structured interviews were conducted with male and female South African undergraduates. The data were thematically analysed. Results revealed that condom use was transient and often unrelated to disease prevention. Condom use was impeded by closer perceived intimacy, gender dynamics, and social stigma against proposing use of condoms in a presumably committed relationship. Public health policies regarding condom, pill and injection pricing / promotion, and religious toleration also hampered condom use, by encouraging a preference over hormonal contraception or proscribing contraceptive measures altogether. The results provide a basis for considering the impact of immediate and wider social contexts on condom use, as proposed by socio-ecological models of HIV risk behaviour.

An integrated model of condom use in Sub-Saharan African youth: A meta-analysis

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. Method: 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 nontrivial 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.

Affect in the Context of Self-Determination Theory

Self-determination theory has been applied to understand the role of affect in motivation and behavior in health contexts. According to self-determination theory, autonomous forms of motivation, reflecting self-endorsed reasons for acting and the satisfaction of psychological needs, are related to participation and persistence in health behavior. Research examining the role of affect in determining health behavior from the perspective of the theory is relatively sparse. Affect has served as both an outcome and process in applications of the theory to health behavior. Positive affect and psychological well-being have been identified as important outcomes of participating in behaviors for autonomous reasons. Affect is inextricably linked to motivational processes through eudaimonic and hedonic well-being, the passionate pursuit of activities, and the regulation of behavior through active management of aversive emotional responses. The chapter outlines how support for autonomous motivation by significant others may lead to adaptive behavioral engagement and affective responses in health behavior.

Developing an integrated theoretical model of young peoples’ condom use in sub‐Saharan Africa

Abstract Objective We aimed to develop an integrated theoretical model of the determinants of condom use in young people from sub‐Saharan African (SSA) nations. Model development was informed by research predicting condom use in SSA nations adopting individual‐level social‐cognitive and socio‐ecological theories, and guided by McMillan and Conners (2007) framework of social‐cognitive predictors of health. Method We conducted a scoping review of research on social‐cognitive and socio‐ecological predictors of condom use in young people in SSA. The integrated model was developed based on the constructs from the review and guided by McMillan and Conners framework to classify the constructs and isolate the processes by which the constructs impact condom use. Results Included studies (N = 45) utilised constructs from seven individual‐level social‐cognitive theories and included multiple socio‐ecological variables as predictors of condom use. The integrated model included dispositions to act as a proximal determinant of condom use which mediated the effect of four categories of social‐cognitive constructs on condom use: attitudes, control perceptions, norms, and self‐representations. Socio‐ecological factors were classified into four categories: relational, individual differences, societal/structural, and community and peer influences. Each had direct and indirect effects on condom use in the model, reflecting the non‐conscious and conscious pathways to action, respectively. Conclusion We expect our integrated model to provide an evidence‐ and theory‐based guide to future research examining the antecedents of condom use in young people in SSA. We also anticipate it will assist in developing targets for interventions that will be effective in promoting condom use in this population.