Mediation analysis of an effective sexual risk-reduction intervention for women: the importance of self-efficacy.
OBJECTIVE
Sister-to-Sister: The Black Women's Health Project is a skill-building HIV/STD risk-reduction intervention for African American women that had significant effects in reducing self-reported sexual risk behavior and biologically confirmed sexually transmitted disease (STD) incidence. The present analyses were conducted to identify which theory-based factors that were addressed in the intervention accounted for its success.


METHODS
The data were collected in the context of a randomized, 5-group intervention trial with assessments at baseline and at 3, 6, and 12 months following the intervention. A mediation analysis was conducted with condom use at last sex, self-reported 12 months after the intervention, as the outcome variable. Mediators were also measured at the 12-month follow-up.


METHODS
Mediators were derived from social cognitive theory: condom use knowledge, hedonistic beliefs regarding effects of condom use, expected sex partner reactions to condom requests, sex partner approval of condom use, self-efficacy for impulse control, self-efficacy for carrying condoms, and self-efficacy to achieve consistent condom use with partner.


RESULTS
The intervention significantly improved all potential mediators except condom use knowledge (p = .15), hedonistic beliefs (p = .08), and self-efficacy for impulse control (p = .20). Analyses testing each mediator separately revealed that expected partner reaction, partner approval of condom use, self-efficacy for condom carrying, and self-efficacy for condom use were significant mediators. When they were entered into a multivariate mediation analysis, however, only self-efficacy for condom use was significant (p = .001).


CONCLUSIONS
These results highlight the importance of self-efficacy in explaining the effects of skill-building sexual risk-reduction interventions on women's use of condoms. Self-efficacy was more important than characteristics of male partners.
O'Leary
Ann
A
Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. aoleary@cdc.gov
Jemmott
Loretta Sweet
LS
Jemmott
John B
JB
D000328:Adult; D001294:Attitude to Health; D017280:Condoms / Q000706:statistics & numerical data; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000517:prevention & control / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D007858:Learning; D040242:Risk Reduction Behavior; D020377:Self Efficacy; D012725:Sexual Behavior / Q000523:psychology*