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Health Psychol. 1993 Jul;12(4):308-12.

Effects of prebehavioral cognitive work on adolescents' acceptance of condoms.

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Family Health Council of Central Pennsylvania, Camp Hill.


Two educational strategies designed to promote condom use for sexually transmitted disease protection were tested in a field experiment involving 291 female, adolescent family planning clinic clients. The 1st strategy was designed to enhance attitude-behavior correspondence by increasing direct experience with handling condoms. The 2nd, a contingency-planning exercise, induced clients to generate a mental representation of negotiating condom use with a sexual partner. Both strategies were compared with the standard education. The dependent measures were condom acceptance (operationalized by the number of condoms taken), attitudes, and knowledge. Clients in the contingency-planning condition accepted about 60% more condoms than did other clients. Condom attitudes followed the same pattern, and knowledge did not differ among conditions.


The effectiveness of two cognitive strategies in promoting condom use among adolescents was compared in a survey of 291 White females, ages 13-19 years (mean age 17.6 years), who presented to 2, US family planning clinics for contraceptive services. All subjects were prior users of oral contraceptives (OCs). Clients were randomly assigned to the 2 experimental groups or a control group that received the standard condom education. These in the 1st experimental approach, based on Pazio's work on enhancing attitude-behavior correspondence through direct personal experience, opened the condom packet and rolled the condom over their fingers. Subjects in the 2nd experimental group, based on research on the relation of cognitive representations of actions to behavior, not only handled the condom personally but additionally were asked to imagine negotiating condom use with a sexual partner. After the educational intervention, subjects were invited to take as many condoms as they wanted from a basket of 20 condoms and given an anonymous questionnaire regarding the number of condoms taken, general attitude toward condom use, condom ever-use, and knowledge of condom effectiveness. Contingency planning group subjects accepted 60% more condoms than controls and 65% more than direct experience group subjects. Favorable attitudes toward condoms showed the same pattern; however, there were no significant differences among groups in terms of knowledge. Although previous condom users accepted almost twice as many free condoms as never-users and held slightly more positive attitudes, the higher condom acceptance and positive attitude rates in the contingency planning group persisted even when previous use was considered in the analysis. Because the 2 interventions were additive, the effectiveness of contingency planning may have been in part due to the interaction with direct experience. Nonetheless, an approach that encourages clients to anticipate barriers to condom use and devise strategies for overcoming them seems particularly well suited to an adolescent population.

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