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Title: Using an extended reasoned action approach to predict and explain "at-risk" online older adults' condom use intentions and inform future tailored intervention development
Author: MacDonald, Jennifer Anne
ISNI:       0000 0004 7231 1844
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2017
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Considerable numbers of older adults are re-entering the dating arena and looking for new sexual partners/to start new romantic relationships. New patterns of sexual mixing bring new risks of sexually transmitted infections [STIs]/HIV. Indeed, English and Scottish sexual health surveillance data show a recent rise in STI/HIV diagnoses among older adults. Online dating may be implicated in this increase, suggesting that older adults who are living in the United Kingdom [UK] and involved in this phenomenon may benefit from intervention. Thus, the overall aim of this thesis was to conduct a programme of formative research to generate and accumulate new knowledge and provide guidance for the development of a theoretically-driven and empirically-based future condom use intervention(s) that is culturally appropriate to UK-based 'at-risk' online older adults. To begin, a systematic review identified and described the existing evidence base of condom use interventions for older adults, synthesised their findings, and evaluated their effectiveness. Five interventions from the United States of America were included, one of which was effective. The review revealed a clear gap - no 'off the shelf' intervention was available for use in a UK context. There was also a lack of definitive guidance directing the most appropriate mode of delivery, use of theory, and intervention content to effect behaviour change. An extended Reasoned Action Approach [RAA] was used to guide theory-driven empirical research that contributes to filling this gap. UK-based 'at-risk' online older women (n = 25), heterosexual men (n = 45), and men who have sex with men [MSM] (n = 29) were recruited to an elicitation study through Facebook adverts. The elicitation study identified and compared the modal (i.e. most commonly held) salient beliefs about condom use for each group so as to inform the questionnaire measures for the indirect (belief-based) RAA constructs in the main study. Qualitative data derived via an online survey were content analysed into categories of salient behavioural (instrumental and experiential), normative (injunctive and descriptive), and control beliefs. Modal salient belief sets were determined per group using five proposed decision rules and appraised for coverage of salient beliefs and impact on main study questionnaire length. Comparisons of the selected final modal salient belief sets revealed discrepancies among groups. Thus, it was necessary to construct three population-specific questionnaires for use in the main study. The main study identified the (RAA-based and non-RAA) proximal determinants of condom use intention for 'at-risk' online older women (n = 109), heterosexual men (n = 97), and MSM (n = 104) recruited via Facebook adverts. Equally, it identified the most suitable key beliefs underlying the RAA-based proximal determinants of condom use intention that could be targeted alongside suitable non-RAA proximal determinants in future tailored interventions. Three cross-sectional online surveys contained closed-ended questions about intention, the direct and indirect (belief- based) RAA constructs, anticipated regret, moral norm, self-identity, future time perspective, and past behaviour. Three-step hierarchical regression analyses revealed that the extended RAA was able to account for significant proportions of the variance in condom use intention among the women (77.5%), heterosexual men (77.5%), and MSM (80.2%). While the independent predictors of condom use intention varied per population, theory-external variables emerged as influential in all instances. The optimal targets for intervention were isolated for each group (women, n = 6; heterosexual men, n - 5; and MSM, n = 4). This work therefore offers important evidence enabling the development of theoretically-driven and empirically-based tailored condom use interventions in the future. Ideas for the primary delivery format and content of such interventions are sketched based on the findings reported here. Recommendations for future research related to feasibility and pilot testing and evaluation are also suggested.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available