Intention to use condom, cusp modeling, and evaluation of an HIV prevention intervention trial.
Intention to use condom, cusp modeling, and evaluation of an HIV prevention intervention trial.
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发表时间：
2013-07
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通讯作者：
Xinguang Chen;B. Stanton;Din Chen;Xiaoming Li
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作者：
Xinguang Chen;B. Stanton;Din Chen;Xiaoming Li
青少年感染艾滋病毒的风险特别高；增加使用避孕套的可能性是降低这种感染风险的有效措施。在评估早期青少年实际使用避孕套行为方面的挑战使使用避孕套意向这一先兆指标成为一个有吸引力的替代方案。在分析一项随机对照试验的数据以评估在早期青少年中促进避孕套使用的理论干预计划时，我们观察到当使用线性分析方法时，对避孕套使用意向的影响不大。如果意图，作为一种行为准备程度的衡量标准，也包含一个非线性离散成分，那么使用非线性方法来建模会更合适。本研究以HIV知识和避孕套技巧为非对称变量，以避孕套使用自我效能为分叉变量，采用尖点突变方法对1360例随机对照试验的数据进行分析。并行和纵向模型分析的结果表明，尖点模型的拟合度要好得多(R2=0.85)；AIC和BIC是线性模型(R2 lt；0.10)或Logistic模型(R2 lt；0.15)的四分之一。接受干预作为一个不对称变量对避孕套使用意向有显著的预测作用，但不能作为一个分叉变量。综上所述，青少年使用避孕套的意图既包含一个连续的过程，也包含一个离散的过程，可以更好地用尖点突变方法建模。如果采取其他措施促进避孕套意向的突然变化，相同的预防干预措施可能会产生更大的项目效果。
Adolescents are at particularly high risk to acquire HIV infection; increasing the likelihood of condom use is an effective measure to reduce the risk of such infections. Challenges in assessing actual condom use behavior among early adolescents render the precursor measure, intention to use condoms, an appealing alternative. While analyzing data from a randomized controlled trial to evaluate a theory-based intervention program to promote condom use among early adolescents, we observed a modest effect with regard to condom use intention when the linear analytical approach was used. If intention, as a measure of the readiness to perform a behavior, also contains a nonlinear discrete component, it would be more appropriately modeled using a nonlinear approach. In this study, data from a randomized controlled trial (N=1360) were analyzed using the cusp catastrophe method with HIV knowledge and condom skills as the asymmetry variables and condom use self-efficacy as the bifurcation variables. Findings from concurrent and longitudinal modeling analyses indicated a much better fit of the cusp model (R2 = 0.85); AIC and BIC were one-fourth that of than the linear (R2 lt; 0.10) or the logistic model (R2 lt; 0.15). Receipt of the intervention as an asymmetry variable was significantly predicted condom use intention but did not as a bifurcation variable. In conclusion, adolescent intentions to use a condom contain both a continuous process and a discrete process and can better be modeled with cusp catastrophe methods. A much greater program effect is likely from the same prevention intervention if additional measures are taken to foster sudden changes in condom intention.