以計劃行為理論探討台灣女大學生之親密暴力經驗與保險套使用之協商意圖與自我效能之關係以計劃行為理論探討台灣女大學生之親密暴力經驗與保險套使用之協商意圖與自我效能之關係

Abstract

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Background and Objectives: Condom negotiation, or the ability to persuade a partner to use a condom, is a behavior unique to women, men who have sex with men (MSM), and other sexual and gender minorities due to their limited behavioral control over condom use. Owing to the fact that the use of condoms is one of the most effective methods for preventing STIs and HIV/AIDs, it is pertinent that the factors associated with condom negotiation among these populations be investigated in order to inform future health education and promotion programs. Therefore, this study, using the Theory of Planned Behavior as a guiding framework, aimed to assess the prevalence of condom use negotiation intention, condom use negotiation self-efficacy, and other related factors, including experience with intimate partner violence (IPV), among female college students in Taiwan. Methods: This study employed purposive sampling to collect data via an anonymous, online survey from August 2020 to November 2020. The inclusion criteria for taking part in the study included being between 18-24 years of age, a biological female, currently enrolled in university, a Taiwanese national, and having ever had at least one intimate partner. A total of 1,762 participants were included in the final analysis. Chi-square analysis, followed by multi-variable logistic regression analysis were used in order to explore the factors significantly associated with having high condom use negotiation intention (CUNI) and high condom use negotiation self-efficacy (CUNSE). Additionally, multinomial logistic regression was used to examine the relationships between participants’ background characteristics and experience with different forms of IPV. Results: This study found that participants who had a positive attitude (ATB) about condom negotiation (AOR=3.573, p<.001), who had perceived support from salient others (SN) about condom negotiation (AOR=2.044, p<.001), and who reported high perceived control (PBC) over condom negotiation (AOR=1.623, p<.001) had significantly higher intention to negotiate condom use than their counterparts. Additionally, as compared to those with no experience with IPV, those having 1-2 instances of IPV and those having experienced all 3 forms of IPV (physical, psychological, and sexual) were 1.4 times and 1.7 times, respectively, more likely to have high CUNI. When examining the factors associated with having high condom use negotiation self-efficacy, it was found that those with a positive attitude (AOR=3.910, p<.001) and those with perceived support from salient others (AOR= 5.619, p<.001) about condom negotiation were more likely to have high CUNSE. Additionally, experience with IPV, including those who reported 3-8 instances of IPV, 9+ instances of IPV, 1 form, 2 forms, and 3 forms, were all significantly likely to have lower CUNSE than their counterparts with no experience with IPV. Lastly, it was revealed that those with history of violence from a non-partner and those who were bisexual experienced greater IPV victimization. Conclusions: This study used the TPB as a guiding framework to systematically examine CUNI and CUNSE, as well as associated factors including experience with IPV, among ever-partnered female Taiwanese university students. Results revealed that those with positive ATB, supportive SN, and high PBC were linked to higher CUNI; however, ATB appeared to be the main driving factor behind high CUNI. For CUNSE, it was found that individual PBC items, as well as supportive SN, were associated with higher CUNSE. The findings about high intention but low self-efficacy related to condom negotiation among those with IPV experience are concerning; this type of dissonance can be associated with the intention-behavior gap which occurs when individuals do not act on their intentions. Additionally, these findings provide empirical evidence that can inform future health education and promotion programs about condom use and negotiation for female college students in Taiwan.