Predictors related to condom use behaviors based on the theory of planned behavior among female sex workers
Huang Jing-yue and Zhang Wei-hua contributed equally to this articel
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摘要:
目的 研究湖北省不同档次场所暗娼（female sex workers，FSWs）安全套使用的影响因素。 方法 基于计划行为理论（theory of planned behavior，TPB）抽查湖北省六市的816名FSWs进行问卷调查，应用结构方程模型分析不同档次场所FSWs在商业性行为中安全套使用的影响因素。 结果 低档场所FSWs最近1次和最近1月商业性行为中安全套使用率均低于中高档场所FSWs（t=5.80，P < 0.001）。不同场所FSWs的TPB评分差异有统计学意义，低档场所FSWs知觉行为控制评分（11.43±2.86）低于中高档场所FSWs（12.06±2.87）（t=3.07，P=0.002）；但行为意图评分（5.47±1.11）高于中高档场所（5.20±1.15）（t=3.35，P=0.001）。知觉行为控制是低档场所FSWs使用安全套的最强影响因素（路径系数为0.55，P < 0.001），而安全套使用意图是中高档场所FSWs使用安全套的最强影响因素（路径系数为0.33，P < 0.001）。对于所有研究对象，安全套使用态度是安全套使用意图的最强影响因素（路径系数为0.49和0.42，P < 0.001）。 结论 提高FSWs对安全套的使用态度是提高FSWs安全套使用意图的重要举措。对于低档场所FSWs，应提高知觉行为控制相关因素；对于高档场所FSWs，应提高其安全套使用意愿。 Abstract:Objective To identify predictors related to condom use in different tiered female sex workers (FSWs) in Hubei Province. Methods A cross-sectional study was conducted in Hubei Province in 2015 to investigate 816 eligible FSWs by using a multistage sampling method. All data were collected by using a structured questionnaire with scales on condom use, which was designed based on the theory of planned behavior (TPB). A structural equation model (SEM) was used to identify predictors of condom use in the different tiered FSWs. Results It showed that low-tier FSWs used less condom than higher-tier FSWs in commercial sexual behaviors of the last time and during the last month(P < 0.001). The TPB scores were significantly different in different tiered FSWs. The scores of PBC in low-tier FSWs were lower than those in higher-tier FSWs (11.43±2.86 vs 12.06±2.87, respectively, P=0.002); But the scores of behavioral intentions were higher than those in higher-tier FSWs (5.47±1.11 vs 5.20±1.15, respectively, P=0.001). The PBC was the major factor related to condom use in low-tier FSWs (effect coefficient=0.55, P < 0.001), while the behavioral intention was the major factor related to condom use in higher-tier FSWs (effect coefficient=0.33, P < 0.001). Behavioral attitude was the major factor of intention to use condoms for both low-tier (effect coefficient=0.49, P < 0.001) and higher-tier FSWs (effect coefficient=0.42, P < 0.001). Conclusions Changing the attitude to condom use in FSWs is an important measure to promote the behavior intention. Condom promotion interventions should focus on the perceived behavioral control in low-tier FSWs, and promote the behavior intention in higher-tier FSWs. -
Key words:
- Female sex workers /
- Condom use /
- Structural equation model /
- Theory of planned behavior
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图 1 低档场所FSWs安全套使用的TPB路径图。
注：模型检验指标：χ2=2.17, GFI=0.927，CFI=0.970，RMSEA=0.062，*P < 0.05, **P < 0.001。
Figure 1. TPB path diagram of condoms use in low-tier FSWS
图 2 中高档场所FSWs安全套使用的TPB路径图。
注：模型检验指标：χ2=2.85，GFI=0.940，CFI=0.974，RMSEA=0.060，*P < 0.05，**P < 0.001
Figure 2. TPB path diagram of condoms use in higher-tier FSWs
表 1 基于TPB的安全套使用测量条目赋值
Table 1. The measurement item assignment of condom use based on the theory of planned behavior
项目 指标变量 赋值结果 1 2 3 行为态度 Q1 艾滋病可以通过安全套来预防 不可以 不清楚 可以 Q2 性病可以通过用安全套来预防 不可以 不清楚 可以 Q3 安全套避孕效果好 不同意 不好说 同意 Q4 不用可以省钱 同意 不清楚 不同意 主观规范 Q5 客人希望我在做生意的过程中应该使用安全套 不希望 不好说 希望 Q6 老板希望我在做生意的过程中应该使用安全套 不希望 不好说 希望 知觉行为控制 Q7 当客人提出不用安全套时，你能否说服他用 不能 不一定 能 Q8 多给钱不使用安全套，你是否会同意 会 不一定 不会 Q9 你接客的时候是否随身携带安全套 否 不一定 是 Q10 在接客的时候是否有足够的安全套使用 否 不一定 是 Q11 购买安全套花费大小 大 一般 小 行为意向 Q12 下一次接客你是否打算使用安全套 不打算 不一定 打算 Q13 下一个月你是否打算持续使用安全套 不打算 不一定 打算 行为 Q14 最近一次商业性行为是否使用安全套 否 - 是 Q15 最近一个月商业性行为是否持续使用安全套 否 有时 是 
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表 2 湖北省不同档次女性性工作者人口学特征[n(%)]
Table 2. Demographic characteristics of different tiered female sex workers in Hubei Province[n(%)]
低档(n=308) 中高档(n=508) χ2值 P值 年龄(岁) 17.51 < 0.001 18~ 126(40.9) 250(49.2) 30~ 108(35.1) 193(38.0) ≥40 74(24.0) 65(12.8) 文化程度 53.60 < 0.001 小学 177(57.5) 169(33.3) 初中 106(34.4) 227(44.7) 高中 23(7.5) 103(20.3) 中专 2(0.6) 9(1.8) 婚姻状况 31.31 < 0.001 未婚 129(41.9) 315(62.0) 已婚 179(58.1) 193(38.0) 支持家用 12.38 < 0.001 是 215(69.8) 216(42.5) 否 93(30.2) 292(57.5) 是否本地 0.22 0.636 是 48(15.6) 73(14.4) 否 260(84.4) 435(85.6) 从事性服务时间(月) 15.28 0.004 < 3 148(48.1) 209(41.1) 3~ 60(19.5) 79(15.6) 6~ 33(10.7) 72(14.2) 12~ 23(7.5) 78(15.4) ≥24 44(14.3) 70(13.8)
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表 3 湖北省不同档次女性性工作者安全套使用情况[n(%)]
Table 3. The condom using behavior of different tiered female sex workers in Hubei Province[n(%)]
低档(n=308) 中高档(n=508) χ2值 P值 最近1次商业性行为是否使用安全套 54.68 < 0.001 是 231(75.0) 474(93.3) 否 77(25.0) 34(6.7) 最近1月商业性行为是否使用安全套 54.42 < 0.001 是 185(60.1) 411(80.9) 否 123(39.9) 97(19.1) 自己购买安全套 116.45 < 0.001 是 124(40.3) 395(77.8) 否 184(59.7) 113(22.2) 当客人多给钱，是否同意无保护性行为 17.27 < 0.001 是 143(46.4) 311(61.3) 否 165(53.6) 196(38.7) 能否劝说客人使用安全套 25.56 < 0.001 是 145(31.2) 330(65.1) 否 163(68.8) 117(34.9)
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表 4 低档和中高档FSWs人群TPB组分评分比较
Table 4. Comparison of TPB components scores in low-tier and higher-tier FSWs
组分 低档(N=308) 中高档(N=508) t值 P值 行为态度 10.38±2.17 10.49±2.07 0.72 0.469 主观规范 4.18±1.53 4.12±1.22 0.51 0.609 知觉行为控制 11.43±2.86 12.06±2.87 3.07 0.002 行为意图 5.47±1.11 5.20±1.15 3.35 0.001 安全套使用行为 5.28±0.93 5.63±0.76 5.80 < 0.001
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