The role of planning and self-efficacy in condom use among men who have sex with men: An application of the Health Action Process Approach model.

Abstract

In Hong Kong, men who have sex with men (MSM) remain a high risk group for HIV infection. This study applied the Health Action Process Approach (HAPA) to study the motivational and behavioral patterns of local MSM in condom use. Four hundred ten sexually active MSM completed the questionnaire on site at Time 1; 217 who remained sexually active were interviewed during a 1-month follow-up. Risk perception, outcome expectancy, action self-efficacy, intention, planning, maintenance self-efficacy, and recovery self-efficacy were measured at Time 1. Actual condom use was measured at both time points. The HAPA model had a good fit to the data (χ2 = 300.71, df = 111, p < .001, CFI = .95, NNFI = .93, RMSEA = .065). Time 2 condom use was predicted by Time 1 planning, maintenance self-efficacy, and intention, which, in turn, was predicted by action self-efficacy, outcome expectancy, and risk perception. Planning mediated the association between intention and actual condom use. No group difference between MSM partners of different sex roles was found. It is demonstrated that the HAPA model could be applied to understand safer sex behavior among Chinese MSM. Its principles can help develop HIV prevention programs targeting safer sex practices by MSM.