Social cognitive predictors of sexual risk behavior change among STD clinic patients

We tested the impact of four social cognitive constructs (multifaceted condom use self-efficacy and hedonic, social, and self-evaluative outcome expectations) on sexual risk behavior change. Each construct was hypothesized to have an independent effect on four indicators of behavior change: consistency of reported condom use, condom use at last intercourse, frequency of unprotected intercourse acts, and stage of condom use behavior change. STD clinic patients (n = 472) were recruited, given baseline interviews, and placed in small-group health education sessions. Three-month follow-up interviews were conducted. Hypotheses were tested with logistic regressions and general linear models. Results showed that baseline self-efficacy and hedonistic expectations regarding condom use predicted sexual behavior and stage of change. In addition, follow-up levels of each of two additional outcome expectation domains, expected partner reaction and self-approval for condom use, were associated with sexual behavior at follow-up, controlling baseline levels of each dependent variable. These latter outcome expectations accounted for the greatest proportion of the variance among the SCT factors. These results support a social cognitive model of condom use behavior change and provide important clues for refining condom promotion interventions.