Skip to main content

Advertisement

SpringerLink
Log in

A Randomized Controlled Trial Evaluating the Efficacy of a Theory-based Intervention Promoting Condom Use Among Chinese Monogamous Female Sexually Transmitted Infection Patients

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Chinese monogamous women may contract sexually transmitted diseases (STD) from their sole male sex partner, but these women do not have high self-efficacy in negotiating about condom use with their regular sex partners.

Purpose

We aim to investigate the relative efficacy of a theory-based and clinic-based cognitive behavioral intervention versus a control intervention in increasing prevalence of condom use with their male sex partner among Chinese monogamous female sexually transmitted disease patients.

Methods

A randomized controlled trial (RCT) was conducted. Participants were randomly allocated into the intervention group (n = 88) or the control group (n = 88). All participants were phone interviewed at baseline and at 2 and 3 months after completion of the baseline survey. The three-session group intervention was based on the information–motivation–behavioral skills (IMB) model. Participants of the control group were provided with educational pamphlets. The primary outcome was consistent condom use in the last month. Relative risks were calculated, and multiple logistic regression models were fit.

Results

As compared to the control group, the intervention group reported higher prevalence of consistent condom use with the sole male sex partner in the last month at month 2 (75.3 versus 59.8 %, RR = 1.26, 95 % CI = 1.01, 1.57) and month 3 (77.8 versus 54.6 %, RR = 1.42, 95 % CI = 1.13, 1.80), whilst the baseline between-group difference was statistically non-significant. Some other secondary outcomes such as “intention to request condom use in the next month even if the sexual partner dislikes using condoms” were also statistically significant. Furthermore, the majority (94 %) of the intervention group members were satisfied with the intervention.

Conclusions

The theory-based intervention is potentially efficacious, but the follow-up period was relatively short. Large-scale randomized clinical trials and subsequent translational research are greatly warranted in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. O'Leary A. Women at risk for HIV from a primary partner: balancing risk and intimacy. Annu Rev Sex Res. 2000;11:191–234.

    PubMed  Google Scholar 

  2. Espirito Santo ME G d, Etheredge GD. Male clients of brothel prostitutes as a bridge for HIV infection between high risk and low risk groups of women in Senegal. Sex Transm Infect. 2005;81(4):342–4. doi:10.1136/sti.2004.011940.

    Article  Google Scholar 

  3. Hor LB, Detels R, Heng S, Mun P. The role of sex worker clients in transmission of HIV in Cambodia. Int J STD AIDS. 2005;16(2):170–4. doi:10.1258/0956462053057567.

    Article  PubMed  Google Scholar 

  4. Lowndes CM, Alary M, Meda H, Gnintoungbe CA, Mukenge-Tshibaka L, Adjovi C, et al. Role of core and bridging groups in the transmission dynamics of HIV and STIs in Cotonou, Benin, West Africa. Sex Transm Infect. 2002;78 Suppl 1:i69–77.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Lau JT, Ho SP, Yang X, Wong E, Tsui HY, Ho KM. Prevalence of HIV and factors associated with risk behaviours among Chinese female sex workers in Hong Kong. AIDS Care. 2007;19(6):721–32. doi:10.1080/09540120601084373.

    Article  CAS  PubMed  Google Scholar 

  6. Lau JT, Gu J, Tsui HY, Chen H, Holroyd E, Wang R, et al. Prevalence and associated factors of condom use during commercial sex by female sex workers who were or were not injecting drug users in China. Sex Health. 2012;9(4):368–76. doi:10.1071/sh11108.

    Article  PubMed  Google Scholar 

  7. Yang C, Latkin C, Luan R, Wang C, Nelson K. HIV, syphilis, hepatitis C and risk behaviours among commercial sex male clients in Sichuan province, China. Sex Transm Infect. 2010;86(7):559–64. doi:10.1136/sti.2009.041731.

    Article  PubMed  Google Scholar 

  8. Zhang C, Li X, Hong Y, Zhou Y, Liu W, Stanton B. Unprotected sex with their clients among low-paying female sex workers in southwest China. AIDS Care. 2012. doi:10.1080/09540121.2012.726345.

    Google Scholar 

  9. Choe HS, Lee DS, Lee SJ, Lee CB, Lee WC, Cho YH. Prevalence of sexually transmitted infections and sexual behavior of young adults and middle-aged people presenting to health examination centers in Korea. J Infect Chemother. 2012;18(2):207–12. doi:10.1007/s10156-011-0319-x.

    Article  PubMed  Google Scholar 

  10. Dai S, Shen Z, Zha Z, Leng R, Qin W, Wang C, et al. Seroprevalence of HIV, syphilis, and hepatitis C virus in the general population of the Liangshan Prefecture, Sichuan Province, China. J Med Virol. 2012;84(1):1–5. doi:10.1002/jmv.22214.

    Article  PubMed  Google Scholar 

  11. Wang J, Jiang B, Siegal H, Falck R, Carlson R. Sexual behavior and condom use among patients with sexually transmitted diseases in Jinan, China. Am J Public Health. 2001;91(4):650–1.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Lau JT, Wang M, Wong HN, Tsui HY, Jia M, Cheng F, et al. Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors. Sex Transm Dis. 2008;35(4):406–13. doi:10.1097/OLQ.0b013e318164467f.

    Article  PubMed  Google Scholar 

  13. Roye CF. Condom use by Hispanic and African-American adolescent girls who use hormonal contraception. J Adolesc Health. 1998;23(4):205–11.

    Article  CAS  PubMed  Google Scholar 

  14. Lau JT, Tang AS, Siah PC, Tsui HY. Assessment of HIV-related sexual risk behaviors among the general female population in Hong Kong. Arch Sex Behav. 2002;31(6):535–42.

    Article  PubMed  Google Scholar 

  15. Abdullah AS, Fielding R, Hedley AJ, Ebrahim SH, Luk YK. Reasons for not using condoms among the Hong Kong Chinese population: implications for HIV and STD prevention. Sex Transm Infect. 2002;78(3):180–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Mizuno Y, Purcell DW, Latka MH, Metsch LR, Gomez CA, Latkin CA. Beliefs that condoms reduce sexual pleasure-gender differences in correlates among heterosexual HIV-positive injection drug users (IDUs). J Urban Health. 2007;84(4):523–36. doi:10.1007/s11524-007-9162-x.

    PubMed Central  PubMed  Google Scholar 

  17. Decker MR, Miller E, Raj A, Saggurti N, Donta B, Silverman JG. Indian men's use of commercial sex workers: prevalence, condom use, and related gender attitudes. J Acquir Immune Defic Syndr. 2010;53(2):240–6. doi:10.1097/QAI.0b013e3181c2fb2e.

    PubMed Central  PubMed  Google Scholar 

  18. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21. doi:10.1016/s0140-6736(04)16098-4.

    PubMed  Google Scholar 

  19. Chen TY, Tang CS. Stress appraisal and social support of Chinese mothers of adult children with mental retardation. Am J Ment Retard. 1997;101(5):473–82.

    CAS  PubMed  Google Scholar 

  20. Goodwin R, Tang C. Chinese personal relationship. In: Bond MH, editor. Handbook of Chinese psychology. Hong Kong: Oxford University Press; 1996. p. 294–308.

    Google Scholar 

  21. Varga CA. The condom conundrum: barriers to condom use among commercial sex workers in Durban, South Africa. Afr J Reprod Health. 1997;1(1):74–88.

    CAS  PubMed  Google Scholar 

  22. Pettifor A, Turner AN, Swezey T, Khan M, Raharinivo MS, Randrianasolo B, et al. Perceived control over condom use among sex workers in Madagascar: a cohort study. BMC Womens Health. 2010;10:4. doi:10.1186/1472-6874-10-4.

    PubMed Central  PubMed  Google Scholar 

  23. You H, Lau JT, Gu J, Tsui HY, Wang Z, Kim JH. Awareness and acceptability of female condoms among monogamous Hong Kong Chinese female sexually transmitted infection patients. AIDS Behav. 2012. doi:10.1007/s10461-012-0376-x.

    Google Scholar 

  24. Desgrees-Du-Lou A, Brou H, Djohan G, Becquet R, Ekouevi DK, Zanou B, et al. Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV preventive attitude among couples. Abidjan, 2002–2005. AIDS Behav. 2009;13(2):348–55.

    PubMed  Google Scholar 

  25. Rou K, Wu Z, Sullivan SG, Li F, Guan J, Xu C, et al. A five-city trial of a behavioural intervention to reduce sexually transmitted disease/HIV risk among sex workers in China. AIDS. 2007;21 Suppl 8:S95–101. doi:10.1097/01.aids.0000304703.77755.c7.

    PubMed  Google Scholar 

  26. Warner L, Klausner JD, Rietmeijer CA, Malotte CK, O'Donnell L, Margolis AD, et al. Effect of a brief video intervention on incident infection among patients attending sexually transmitted disease clinics. PLoS Med. 2008;5(6):e135. doi:10.1371/journal.pmed.0050135.

    PubMed Central  PubMed  Google Scholar 

  27. Cohen DA, MacKinnon DP, Dent C, Mason HR, Sullivan E. Group counseling at STD clinics to promote use of condoms. Public Health Rep. 1992;107(6):727–31.

    CAS  PubMed Central  PubMed  Google Scholar 

  28. Lowndes CM, Alary M, Labbe AC, Gnintoungbe C, Belleau M, Mukenge L, et al. Interventions among male clients of female sex workers in Benin, West Africa: an essential component of targeted HIV preventive interventions. Sex Transm Infect. 2007;83(7):577–81. doi:10.1136/sti.2007.027441.

    CAS  PubMed Central  PubMed  Google Scholar 

  29. Ramesh BM, Beattie TS, Shajy I, Washington R, Jagannathan L, Reza-Paul S, et al. Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, South India. Sex Transm Infect. 2010;86 Suppl 1:i17–24. doi:10.1136/sti.2009.038513.

    PubMed Central  PubMed  Google Scholar 

  30. Lau JT, Wang R, Chen H, Gu J, Zhang J, Cheng F, et al. Evaluation of the overall program effectiveness of HIV-related intervention programs in a community in Sichuan, China. Sex Transm Dis. 2007;34(9):653–62. doi:10.1097/01.olq.0000260948.10572.b9.

    PubMed  Google Scholar 

  31. Phillips B, Ball C, Badenoch D, Straus S, Haynes B, Dawes M. Levels of evidence. BJU Int. 2010;105(9):1351.

    Google Scholar 

  32. Gardner B, Whittington C, McAteer J, Eccles MP, Michie S. Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Soc Sci Med. 2010;70(10):1618–25. doi:10.1016/j.socscimed.2010.01.039.

    PubMed  Google Scholar 

  33. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    CAS  PubMed  Google Scholar 

  34. Fisher JD, Fisher WA, Misovich SJ, Kimble DL, Malloy TE. Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population. Health Psychol. 1996;15(2):114–23.

    CAS  PubMed  Google Scholar 

  35. Wang K, Lee AH, Hamilton G, Yau KK. Multilevel logistic regression modelling with correlated random effects: application to the smoking cessation for youth study. Stat Med. 2006;25(22):3864–76. doi:10.1002/sim.2472.

    PubMed  Google Scholar 

  36. Yan J, Lau JT, Tsui HY, Gu J, Wang Z. Prevalence and factors associated with condom use among Chinese monogamous female patients with sexually transmitted infection in Hong Kong. J Sex Med. 2012;9(12):3009–17. doi:10.1111/j.1743-6109.2012.02945.x.

    PubMed  Google Scholar 

  37. Lau JT, Cai W, Tsui HY, Cheng J, Chen L, Choi KC, et al. Prevalence and correlates of unprotected anal intercourse among Hong Kong men who have sex with men traveling to Shenzhen, China. AIDS Behav. 2012. doi:10.1007/s10461-012-0244-8.

    Google Scholar 

  38. Xiao Z. Correlates of condom use among Chinese college students in Hunan province. AIDS Educ Prev. 2012;24(5):469–82. doi:10.1521/aeap.2012.24.5.469.

    PubMed  Google Scholar 

  39. Zhao J, Song F, Ren S, Wang Y, Wang L, Liu W, et al. Predictors of condom use behaviors based on the health belief model (HBM) among female sex workers: a cross-sectional study in Hubei province, China. PLoS One. 2012;7(11):e49542. doi:10.1371/journal.pone.0049542.

    CAS  PubMed Central  PubMed  Google Scholar 

  40. Fisher JD, Fisher WA. Theoretical approaches to individual-level change in HIV risk behaviour. In: Peterson JL, DiClemente RJ, editors. Handbook of HIV Prevention. New York: Kluwer Academic/Plenum Publishers; 2000. p. 3–55.

    Google Scholar 

  41. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008.

    Google Scholar 

  42. Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS Behav. 2008;12(3):335–53. doi:10.1007/s10461-007-9313-9.

    PubMed  Google Scholar 

  43. Boyer CB, Shafer MA, Shaffer RA, Brodine SK, Pollack LM, Betsinger K, et al. Evaluation of a cognitive-behavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women. Prev Med. 2005;40(4):420–31. doi:10.1016/j.ypmed.2004.07.004.

    PubMed  Google Scholar 

  44. Carey MP, Maisto SA, Kalichman SC, Forsyth AD, Wright EM, Johnson BT. Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women. J Consult Clin Psychol. 1997;65(4):531–41.

    CAS  PubMed Central  PubMed  Google Scholar 

  45. Kalichman SC, Cain D, Weinhardt L, Benotsch E, Presser K, Zweben A, et al. Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychol. 2005;24(2):198–208. doi:10.1037/0278-6133.24.2.198.

    PubMed  Google Scholar 

  46. Laven H. Self-reported data may be unreliable. J Prim Health Care. 2012;4(4):350–1.

    PubMed  Google Scholar 

  47. Strite SA, Stuart ME. Importance of blinding in randomized trials. JAMA. 2010;304(19):2127–8. doi:10.1001/jama.2010.1621. author reply 8.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully thank the study participants for their contribution and the Department of Health for its support. This study was financially supported by The Hong Kong Council for the AIDS Trust Fund.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

    Joseph T. F. Lau & Jinghua Li

  2. CUHK Shenzhen Research Institute, Shenzhen, China

    Joseph T. F. Lau

  3. The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

    K. C. Choi

  4. School of Public Health, Sun Yat-sen University, Guangzhou, China

    Jing Gu

  5. Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F., School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, China

    Joseph T. F. Lau

Authors
  1. Joseph T. F. Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinghua Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. C. Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph T. F. Lau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lau, J.T.F., Li, J., Choi, K.C. et al. A Randomized Controlled Trial Evaluating the Efficacy of a Theory-based Intervention Promoting Condom Use Among Chinese Monogamous Female Sexually Transmitted Infection Patients. Int.J. Behav. Med. 21, 719–729 (2014). https://doi.org/10.1007/s12529-014-9388-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-014-9388-4

Keywords

Search

Navigation