Stages of condom use and decisional balance among college students in Taiwan

Background: Only one quarter of sexually active Taiwanese college students use condoms consistently and 55% report having more than two sexual partners during their lifetime. The Transtheoretical Model (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 pre-contemplation, contemplation, or preparation stage. The objectives of this study were to explore sexual behaviors and condom use and differences in specific items of perceived benefits and barriers to condom using the TTM stages among college students in southern Taiwan.

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, a sexual history and condom use scale, and condom use decisional balance scale. Data were analyzed descriptively and with multiple linear regression.

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 = .031) and protecting their partners as well as themselves (p = .028), and perceived more barriers in believing that using condom needs to rely on partner's cooperation (p = .046) than participants in pre-contemplation. Participants in pre-contemplation and contemplation perceived more barriers related to worry about making their partner angry if condoms were used than those in action/maintenance (p = .008).

Conclusions: Low levels of condom use among Taiwanese college students remain a significant public health concern. Results of this study suggest that interventions which enhance the perceived benefits (e.g., using condoms protects their partners as well as themselves) and lowering perceived barriers (e.g., making partner angry by using condoms) for college students who are in the pre-contemplation stage may be useful in promoting thinking about implementation new condom use behaviors. HIV prevention programs based on knowledge of the TTM stages of change and directed at specific perceived barriers or benefits to condom use gives nurses an opportunity to develop theory driven, evidence-based nursing practice.