Condom use among Black women: A theoretical basis for HIV prevention guided by Neuman Systems Model and Theory of Planned Behavior

Most studies on condom use for the prevention of sexually transmitted HIV among Black women involve low-income populations. However, little is known of condom use among Black women of varying levels of socioeconomic status. The purpose of this study based in the Neuman Systems Model and the Theory of Planned Behavior was to test the relation of socioeconomic status, beliefs, attitudes, subjective norm, perceived behavioral control, condom use intention, and condom use behavior in Black women. This study was accomplished in three phases. Phase I consisted of focus groups to elicit condom use-related beliefs from Black heterosexual women regarding the prevention of sexually transmitted HIV. Data was analyzed through content analysis and used to develop an instrument to measure study variables. Pilot testing of the instrument occurred in Phase II for feasibility. The instrument was used in Time 1 of Phase III to collect baseline data for socioeconomic status, condom use beliefs, attitudes, subjective norm, and perceived behavioral control on condom use intention for the next month. Phase III, Time 2, consisted of a one-month follow-up of Time 1 subjects to examine study variables on condom use behavior during the preceding month. Data was analyzed by path analysis (Phase III, Time 1 and Time 2). The results of Time 1 data on the final sample revealed that no significant relations were found to exist between SES and normative beliefs weighted by motivation to comply or control beliefs weighted by perceived power. Attitude, subjective norm, and perceived behavioral control were all found to be significant predictors of intention. Time 2 data results indicated that intention was a significant predictor of behavior. Contributions of SES were inadequate to support the extension of the Theory of Planned Behavior in this study. However, Ajzen\u27s Theory of Planned Behavior was empirically adequate to explain condom use intention and behavior among socio-economically diverse Black women. Also, study findings supported the utility and credibility of an extended version of the Neuman System Model