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Health Chapter Six.docx

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Wilfrid Laurier University
Lawrence Murphy

Chapter Six: Theories, Models and Interventions Applied to Sexual Health Sexual Behaviour: Any activity that arouses sexual arousal for pleasure or procreation  Leads to an exchange in bodily fluids  Can have serious consequences: Pregnancy, HIV and sexually transmitted infections Incidence and Prevalence of STIs, HIV and AIDS STIs: passed through intimate sexual contact  Common STIs are chlamydia, genital warts and gonorrhea  Most severe are syphilis and HIV but they are more rare  Greatest affected age group is 16-24 years - In the UK, the incidence of STIs has been steadily rising since the 1990s - 399,738 new cases of STIs were reported in 2008 - Until 2009, over 102,000 people in Britain have been diagnosed with HIV - Prevalence of HIV across the globe has been rising steadily with the majority (67%) in Sub-Saharan Africa - US stats: Center for Disease Control reported teenage pregnancies and syphilis rose sharply among US school girls under the Bush administration - Birth rates for teenage girls 15 and older were in decline since 1991 but have increased sharply since 2005 in more than half of American states - Southern states, where there is the greatest emphasis on abstinence and religion, tend to have the highest rates of teenage pregnancy and STIs Knowledge, Awareness and Condom Use - A nation AIDS trust (2008) survey showed widespread ignorance about STIs and HIV  1 in 5 people in the UK couldn’t identify how HIV is transmitted  There was an increase in the number of people using condoms in a relationship until ‘we’ve both been tested for STIs and HIV - 57% of young people in south-east Asia know little about HIV and AIDS as compared to 74.3% of young Africans : - Sexual risk taking has been associated with poorer academic performance  Possible mediator is alcohol and drug use - All studies on sexual behaviour using self-reports tend to find disparities - Randrianasolo (2008) suggested barriers to using modern contraceptives were:  Gaps in knowledge  Misinformation and negative perceptions  Concerns about social oppositions - Alcohol and drug use prior to sexual activity compromises sexual decision making and increases unsafe sexual contact - Negative psychological consequences, guilt and reduced self-esteem, tend to follow unplanned sexual activity - Culture, motivational and emotion factors play role in low condom usage Individual-Level Theories and Models - Use theoretical concepts and models as a basic for studying people’s actions and choices  Top-down process considering its based on preconceived theoretical ideas  Interventions using this approach are constructed without any involvement of the intended participants - Eight main theories which have informed interventions targeted at individual sexual risk taking 1. Health Belief Model: Cognitive model examining the predictors and precursors to health behaviour - Four constructs: 1) Perceived susceptibility—individual assessment of risk of getting condition 2) Perceived severity—individual assessment of seriousness of condition and potential consequences 3) Perceived barriers—individual assessment of influences that facilitate/discourage adoption of the promoted behaviour 4) Perceived benefits—individual assessment of positive consequences of adopting the behaviour - Cues to action are reminders or prompts to take action consistent with an intention  Increase likelihood of a behaviour  Can be internal (i.e., feeling fatigued can trigger actions to taking time to relax) or external (i.e., personal communication from health professions)  Over the years, additional factors such as demographic, psychosocial and structural factors have been added to the model - Several studies done using the HBM model have yielded mixed results decreasing its accountability 2. Protection Motivation Theory: describes coping with a health threat in light of two appraisal processes, threat appraisal and coping appraisal - According to PMT, behaviour change is best achieved by appealing to an individual’s fears - The appraisal of the health threat and the possible coping response result in an intention or protection motivation to perform adaptive or maladaptive response - Four constructs that influence the intention to protect oneself against threat 1) Perceived severity of a threatened event (i.e., HIV infection) 2) Perceived probability of occurrence (i.e. vulnerability to HIV) 3) Efficacy of the preventative behaviour (i.e., how effective are condoms) 4) Perceived self-efficacy (i.e., person’s confidence in putting condom in place) - Take accounts of both cost and benefits of behaviour in predicting likelihood of change - PMT assumes protection motivation is maximized when:  Threat to health is severe  Individual feels vulnerable  Adaptive response is believed to be an effective means averting threat  Person is confident in abilities to complete adaptive response  Rewards associated with maladaptive behaviour are small  Costs associated with adaptive response are small Li et al. (2004) studied HIV/STD risk behaviours and perceptions among 2153 sexually active rural-to-urban migrants in China. - Migration often places individuals at increased risk for HIV and STI - High mobility among the rural-to-urban migrant population was associated with increased sexual risk - Increased sexual risk was associated with increased perceptions of extrinsic rewards, intrinsic rewards and response cost - All seven PMT constructs were found to be associated with sexual risk in the manner posited by the theory 3. Theory of Reasoned Action: based on the assumption that a person is likely do what they intend to do - Three constructs: 1) Behavioural intention 2) Attitude 3) Subjective norm - Assumes that a person’s behavioural intention depends on the person’s attitude about the behaviour and subjective norms Attit
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