Using the Theory of Planned Behavior to Predict Condom use Among Men Who Have Sex with Men in upper Northern Thailand

Abstract

HIV/AIDS and sexually transmitted infections (STIs) remain significant public health concerns in Thailand, with men who have sex with men (MSM) particularly vulnerable to these infections. Condom use emerges as a highly effective preventive measure against HIV/AIDS and STIs. However, recent research reveals a concerning trend—MSM are increasingly opting for less frequent condom use. Given this concern, a cross-sectional study was conducted with the aim of exploring the relationship and predictive capacity of the Theory of Planned Behavior (TPB) concerning intentions and condom use behaviors within the MSM community in Northern Thailand. A total of 342 MSM were recruited using snowball sampling and convenience sampling. Data were collected using a self-administered questionnaire, which consisted of six sections: demographic information, condom use behavior, condom use intention, attitude toward condom use behavior, subjective norm of condom use, and perceived control of condom use behavior. The data were collected between January 1 and March 31, 2023. The statistical methods employed for data analysis encompassed descriptive and inferential statistics, including Spearman's rank correlation coefficient and a logistic regression model. The study's findings highlighted several key points. Factors associated with condom use intention included personal attitude toward condom use behavior (r = 0.52, p-value < 0.001), subjective norm of condom use (r = 0.18, p-value = 0.01), and perceived control of condom use behavior (r = 0.37, p-value < 0.001). The factors associated with condom use behavior were condom use intention (r = 0.59, p-value < 0.001) and perceived control of condom use behavior (r = 0.27, p-value < 0.001). A multiple logistic regression model was used to examine the predictive power of the TPB on condom use intention. The results showed that the TPB could predict condom use intention by 36% (Nagelkerke R2 = 0.36). The factors associated with this prediction were as follows: Groups with high levels of attitude toward condom use behavior were 4.36 times more likely to have consistent condom use intentions than groups with low or medium levels of attitude toward condom use behavior (95% CI = 2.17-8.77). Moreover, groups with a high level of subjective norm of condom use were 1.82 times more likely to have consistent condom use intention than groups with a low level of subjective norm of condom use (95% CI = 0.75–4.44). Additionally, groups with a medium level of subjective norm of condom use were 1.06 times more likely to have consistent condom use intention than groups with a low level of subjective norm of condom use (95% CI = 0.50-2.26). Furthermore, groups with a high level of perceived control of condom use behavior were 7.85 times more likely to have consistent condom use intentions than groups with low or medium levels of perceived control of condom use behavior (95% CI = 3.34–18.47). Additionally, the TPB can predict condom use behavior by 21% (Nagelkerke R2 = 0.21). The factors associated with the prediction were as follows: Groups with a high level of condom use intention were 8.61 times more likely to have consistent condom use behavior than groups with low or medium levels of condom use intention (95% CI = 4.06–18.26). Furthermore, groups with a high level of perceived control of condom use behavior were 1.59 times more likely to have consistent condom use behavior than groups with low or medium levels of perceived control of condom use behavior (95% CI = 0.71-3.53). In light of these findings, it is imperative to develop behavioral modification programs or communication campaigns that focus on cultivating a positive attitude toward condom use behavior and emphasize the value of condom use. These programs should also include training in the correct use of condoms and skills for managing situations that promote safe sex. This comprehensive approach will instill greater confidence among MSM in using condoms consistently.