Wei-Chen Tung

Applying the transtheoretical model to cervical cancer screening in Vietnamese-American women

BACKGROUND Low levels of Papanicolaou (Pap) screening participation in Vietnamese-American women remain a significant public health problem. The transtheoretical model (TTM) suggests that individuals adopting Pap smear behaviour move through a series of stages of readiness to change. Determining a womans level of readiness for regular Pap testing and identifying the screening behaviour that an individual already performs is important in the development of successful intervention programmes that address the specific needs of Vietnamese-American women in different stages. AIMS To describe Pap smear screening behaviours of Vietnamese-American women, and to examine whether constructs (stages of change, self-efficacy and perceived benefits/barriers) from the TTM are applicable to Vietnamese-American women relative to Pap testing. METHODS A descriptive, cross-sectional design with snowball sampling was used to recruit participants. A total of 80 Vietnamese-American women completed the self-administered questionnaire. RESULTS Most respondents (62.5%) reported previous Pap testing and only 46.3% receiving regular Pap testing. Compared with those in the pre-contemplation stage of the TTM, participants in maintenance reported significantly less self-efficacy (F (3, 73) = 4.85, P = 0.00), a lower level of perceived barriers (F (3, 75) = 5.99, P = 0.00) and a higher level of perceived benefits (F (3, 76) = 3.91, P = 0.01) relative to Pap smear. CONCLUSIONS The results support some of the assumptions of the TTM but raise questions about the predicted relationships between stages of change and self-efficacy. Continued research is needed to identify the most effective theory-based interventions for evidence-based nursing practice in this population.

Knowledge, Attitudes, and Behaviors Related to HIV and AIDS Among College Students in Taiwan

&NA; HIV infection rates in Taiwan have been growing at nearly 15% per year since 1997, one of the fastest rates in Asia. Little is known about the knowledge, attitudes, and sexual behaviors of college‐age young adults in Taiwan. This study assessed the knowledge, attitudes, sources of HIV information, and behaviors related to HIV among college students; it also explored variables associated with the knowledge and attitudes about HIV among college students in Taiwan. Data were collected through a self‐administered questionnaire from 132 Taiwanese college students enrolled in two private universities. Study results showed that fewer than half (48.5%) of the participants were aware that HIV could be spread through infected semen, and, nearly a quarter of participants believed that HIV could be contracted through mosquito bites, toilet seats, or swimming pools. Only 29.5% reported ever having had sex. This research provides additional insights that may be used to develop effective HIV prevention strategies in Taiwan.

Acculturative Stress and Help-Seeking Behaviors Among International Students:

The number of international students studying at colleges and universities in the United States is continuing to grow. Approximately 691,000 international students enrolled in various institutions of higher education in the United States during the 2009-2010 academic year, representing a 2.9% increase over the previous year (Institute of International Education, 2010). About 60% of all international students arrive from Asia, with the largest representation from India, China, and South Korea. International students bring diverse cultural perspectives that enrich American college campuses. At the same time, international students may face a unique set of challenges related to the adjustment to a new cultural environment. This column describes the acculturative stress experienced by international students living and studying in the United States and their help-seeking behaviors. Implications for practice are also discussed.

Benefits and Barriers of Pap Smear Screening: Differences in Perceptions of Vietnamese American Women by Stage

Low participation in Papanicolaou screening among Vietnamese American women remains a significant public health problem. This study explored differences in the perceived benefits of and barriers to obtaining Papanicolaou smears within the framework of the transtheoretical model stages of readiness. A descriptive, cross-sectional design with snowball sampling was used to recruit 80 Vietnamese American women. The self-administered questionnaire included a Demographic Questionnaire, Cervical Cancer Screening Stage Questionnaire, and Benefits/Barriers Scale. Results suggest that knowledge of cervical cancer, awareness of screening programs, and availability of female physicians play important roles in the transition from precontemplation to maintenance within the transtheoretical model framework.

HIV knowledge and condom intention among sexually abstinent Chinese students.

AIMS To (a) assess the HIV/AIDS knowledge and sources of HIV/sexually transmitted infection (STI) information among sexually abstinent college students in China; (b) examine whether constructs from the transtheoretical model (TTM) are applicable to this study population regarding condom use intention; and (c) evaluate the association between genders and TTM constructs, and HIV/AIDS knowledge. BACKGROUND Chinese college students are vulnerable to HIV and other STIs. Strategies targeting abstinent students are more cost-effective than providing treatment for diseases. METHODS We surveyed 390 students enrolled in two universities in China. Data were collected from June 2009 to March 2010. RESULTS Only 11% and 24% were aware of HIV spread by infected semen and of the protective effects of condom use against HIV. The mass media were major sources of HIV/STI information. Individuals who had higher levels of self-efficacy and reported more perceived benefits and fewer perceived barriers were more likely to be in TTM contemplation stage of condom use than those in precontemplation. Females were less likely to discuss HIV/STIs through online chat or email with strangers than males. Individuals who had higher levels of self-efficacy and reported more perceived benefits and fewer perceived barriers were more likely to be in TTM contemplation stage of condom use than those in precontemplation. CONCLUSION Sexually abstinent college students in China may be more likely to transition from precontemplation to contemplation if they know the benefits of condom use for the prevention of HIV/STIs and if they learn to successfully minimize potential barriers related to condom use.

Knowledge, Attitudes, and Behaviors Related to HIV and AIDS among Female College Students in Taiwan

ABSTRACT Our purpose was to assess the knowledge and attitudes, source of HIV and AIDS information, and behaviors related to HIV and AIDS among female college students in Taiwan and to explore the factors associated with knowledge and attitudes of HIV and AIDS among female college students in Taiwan. We employed a descriptive cross-sectional design. Using a mail survey, the investigators collected data from a convenience sample of 99 female undergraduate students at a 4-year university in Taiwan. The self-administrated questionnaire included a demographic questionnaire and the International AIDS Questionnaire—Chinese Version. Our study revealed that the majority of respondents (68%) were sexually active in the last year. Findings revealed that the sexually active women had more overall HIV and AIDS knowledge and attitudes compared to those who were not sexually active. Overall, findings revealed a significant number of participants were not aware of HIV and AIDS facts and held many myths about the transmission of HIV and AIDS. Accurate HIV and AIDS information is the first step in preventing the spread of this epidemic. Ideally, the fight against AIDS should involve the family, education system, mass media, and society at large; however, the lack of necessary knowledge, values, and skills often results in ineffective and inconsistent HIV and AIDS prevention programs.

Stages of condom use and decisional balance among college students.

AIMS To explore sexual behaviours and condom use and differences in specific items of perceived benefits and barriers to condoms using the Transtheoretical Model (TTM) stages among college students in southern Taiwan. BACKGROUND The TTM suggests that individuals in the action or maintenance stage exhibit higher levels of perceived benefits and lower levels of perceived barriers related to condom use than people in the precontemplation, contemplation or preparation stage. METHODS This was a descriptive, cross-sectional design with cluster sampling among college students from two universities in southern Taiwan. Participants completed self-administered questionnaires, including demographic data, Sexual History and Condom Use Scale and Condom Use Decisional Balance Scale. RESULTS Of the 279 participants, 57% were sexually active, of these only 11.9% used condoms consistently. Respondents in the TTM stage of action/maintenance perceived greater benefits in relation to feeling more responsible (P = 0.031) and protecting their partners as well as themselves (P = 0.028), and perceived more barriers in believing that using condom needs to rely on partners cooperation (P = 0.046) than participants in precontemplation. Participants in precontemplation and contemplation perceived more barriers related to worry about making their partner angry if condoms were used than those in action/maintenance (P = 0.008). CONCLUSION Low levels of condom use among Taiwanese college students remain a significant public health concern. HIV prevention programmes for college students in Taiwan may be enhanced if they incorporate readiness to change and perceived benefits and barriers. Future research should include a larger sample with diverse groups.

Sexual behavior, stages of condom use, and self-efficacy among college students in Taiwan

Abstract The purposes of this study were: (1) to assess sexual behaviors and condom use behaviors; (2) to compare sexual behaviors and condom use behaviors between gender groups; and (3) to explore differences in specific items of self-efficacy to practicing condom use by the transtheoretical model stages of readiness to change among college students in Taiwan. A survey of students at two universities yielded 996 valid responses. The survey questions collected reports of demographic information, sexual history, condom use in general, and likely condom use in specific situations in relation to self-efficacy. Only 27.8% (n=277) reported ever having had sex, of these only 31.4% used condoms every time (those in action and maintenance). Condom use among women was lower than among men with men 5.1 times more likely to use condoms to prevent sexually transmitted infections (OR=5.1, 95% CI: 2.14–12.16, p=0.0002). The stages of change model with reported attitudes (self-efficacy) toward condom use in specific situations. The Tukey–Kramer multiple comparisons showed that participants in the maintenance stage reported significantly higher scores than those in the pre-contemplation, contemplation, and preparation stages for all 10 self-efficacy items (p<0.0001). Circumstances that are the most challenging for condom adherence across the stages are: partner preference to forego use, situations involving alcohol and drug use, and perceived low-risk scenarios. College students in Taiwan would benefit from targeted interventions that link risky sex to alcohol, and that address the interpersonal pressure within relationships that compel women students to practice unsafe sex.

Condom Use and Stages of Change Among College Students in Taiwan

OBJECTIVES To explore the correlates for nonuse of condoms and the factors that affect stages of change for regular condom use among college students in Taiwan. DESIGN AND SAMPLE Cross-sectional, quantitative survey design. A total of 996 college students were recruited from two universities in Northern Taiwan. MEASURES Questionnaires collected data on demographic information, condom use, HIV/AIDS knowledge, confidence in using condoms in different situations, and perceived benefits and barriers to using condoms. RESULTS The common reasons for not using condoms were trust in the partner (21.30%), partner dislike for condoms (19.49%), and perception of low risk (18.77%). Most sexually active students (52.4%) were in the earliest 2 stages of readiness to change (i.e., precontemplation, contemplation). Participants in action/maintenance were (a) 43.4% less likely to show a high knowledge score, (b) 4.08 times more likely to present high self-efficacy, and (c) 2.24 times more likely to be more religious than those in contemplation/preparation. CONCLUSIONS Among a highly literate group, college students, condom use is inconsistent and readiness to change is not imminent. This study reveals that preventive steps targeted at young adults should address other concerns related to condom use such as trust in partners and the alleged appeal of unprotected sex.

Papanicolaou Screening in Taiwan: Perceived Barriers and Self-Efficacy

Cervical cancer remains a leading cause of death in Taiwan, and frequency of screening remains low. We surveyed Taiwanese women about beliefs and practices related to cervical screening, searching for perceived barriers and self-efficacy using the transtheoretical model. We assessed demographics, 12 perceived barriers, and seven self-efficacy measures for 222 Taiwanese women. Data were analyzed descriptively and with multiple linear regression. Barriers related to worry, embarrassment, stigma, and the lack of female physicians were significant in the relapse stage. All self-efficacy measures were significant across various stages of change. Interventions should focus on relapsers and on information related to self-efficacy.