| BackgroundThe report data showed that the proportion of elderly men infected with human immunodeficiency virus(HIV)and syphilis and other sexually transmitted diseases(STDs)was large and showed an upward trend year by year in recent years.It was considered to be the main way of AIDS/STDs transmission among the elderly men that seeking commercial sexual behavior in older female sex workers(OFSWs).Because of the low charge of OFSWs,concealed trade places and psychological characteristics of elderly men who were not afraid or caring of AIDS/STDs,the rate of condoms use in commercial sex is relatively low,which greatly causes STDs/HIV to spread in the elderly men.Condoms are considered to be the most effective measure to prevent AIDS/STDs’ transmission.Therefore,it is very important to study the influencing factors of condoms use among OFSWs and take interventions to prevent the transmission of STDs/HIV from high-risk group spreading to general population.At present,theoretical models of health behavior are widely used in the study of health behavior.The information-motivation-behavioral skills(IMB),socio-cognitive model(SCM)and the theory of planned behavior(TPB)were more used in the study of condoms use.In past studies,one of the models was used to study condoms use and explore its main preventive behaviors.However,three models were not applied to the same population at the same time.Therefore it is impossible to decide which model is more suitable for the condoms use behavior of some population.Studies showed that the infection rate of OFSWs AIDS/STDs was significantly higher than that of common FSWs.Therefore,the unsafe sexual behaviors of OFSWs are more serious than that of common FSWs.Acquaintances were the main objects of OFSWs with whom did not use condoms.So to study the condoms use of OFSWs with acquaintances have great significance.Previous studies had explored the influencing factors of condoms use behavior and attitude respectively,When the two are not unified-the OFSWs attitude is positive but the behavior is negative.The results can not reflect the overall attribute of OFSWs’ condoms use.The latent category analysis provides us with a research method,which can combine the two into a latent variable,and OFSWs can be divided into different categories of the same latent variable according to the attitude and behavior,which can better reflect the overall properties of the condoms use among OFSWs.Exploring influencing factors of different categories can provide evidence for relevant departments to intervene specific groups of people.Objectives1 To build structural equation model(SEM)respectively according to the theory of IMB,SCM,TPB and results of the present studies to explore the influencing factors of condoms use s and the most suitable model among OFSW,so this study can provide a reference for the interventions of relevant departments and the researches in the future;2 Applying latent class analysis to explore attitude and behavior pattern of condoms use with regulars and its influencing factors among OFSWs.It has great significance for characteristics and prediction of OFSWs’ condoms use with regulars and it can provide a theoretical basis for future interventions on specific patterns of population.MethodOFSWs were recruited with respondent-driven sampling method during March to June 2014.Computer assisted personal interviewing(CAPI)were used to survey OFSWs after the informed consent.The questionnaire used China social network questionnaire with face-to-face form.The questionnaire included general demographic characteristics,work conditions,health or high-risk behavior factors,sexual behaviors,condoms use,self-efficacy,personal sense of honor,sense of collective honor and other related information.Establishing SEM to analysis influencing factors of OFSWs’ condoms use according to the theory of IMB,SCM,TPB and comparing the applicability of the three theoretical models;Using the latent class model to explore OFSWs’ condoms use attitude and behavioral pattern and applying χ2 test and logistic regression analysis to explore influencing factors of the attitude and behavior pattern.Results1 The basic characteristics of OFSWsThe age of 420 OFSWs was 35～60 years old,with an average age of 42.5±6.3 years old.98.3%of them were Han ethnics and 61%were divorced/widowed.72.6%of them accounted for 72.6%of Qingdao’s household registration.46%OFSWs were primary school education and 46%of them were junior high school education.85.7%OFSWs’ business income was 4000 yuan or above and 54.3%of them being female sex workers were more than 5 years.80%OFSWs had sex trade at a fixed place and 75%had received HIV test and 87.6%had received different forms of HIV services.81.7%OFSWs said they had not taken drugs and 47.6%of them had suffered a violent.2 The situation of SEM componentsThe knowledge score of AIDS/STDs transmission was 0-11 points,the average score was 8.08±2.58.The overall awareness of AIDS/STDs was pretty better;the score range of prevention knowledge was 0-6,the average score was 3.90±0.62,and most of OFSWs had the correct cognition of condoms;the guests support was poor and the score range was 0-4,The average score was 1.75±0.96.In the last month,only 2.4%answered that the guests always asked to use condoms;the peer support score rang was 0-6 and the average score was 5.04±1.08.The result showed that the peer support was good;the peer use was poor,the score rang was 1-5,the average score was 1.81±0.72,0.1%thought that most OFSWs often used condoms;the score range of the infection crisis was 2-6 points,the average score was 3.44±1.16.OFSWs was weak in the crisis of AIDS,and no one believed that she would be infected;the personal honor score rang was 6-24,the average score was 16.84±3.07,and more than 80%OFSWs had stronger sense of personal honor and disgrace;the score rang of collective sense consciousness was 3-60 and the average score was 29.0617.37.Most OFSWs thought that it was important to keep the relationship between friends and themselves,but it was not very important.The score range of the condoms use was 0-5 and the average score was 3.07±0.75.The attitude of the condoms use with the fixed partner was negative;the negative expectation score range was 1-14 points and the average score was 8.54±1.90.The negative expectation of OFSWs to the condoms itself was not high,but the negative expectation was higher for the condoms use,and the OFSWs self-efficacy was higher and score range was 0-6,the average score was 3.07±0.74;the personal self-control was strong,the score range was 0-12,the average score was 8.67±2.48;the score range of the condoms use intention was 0-6,the average score was 4.98±1.09,the score range of the use behavior was 3-9,the average score was 7.53±1.38.The intention of condoms use was stronger and the behavior was positive.3 Using IMB model to explore the influencing factors of OFSWs condoms useIn the IMB model,motivation and behavioral skills had a greater impact on condoms use,and the total effects were 0.698 and 0.819 respectively.Among them,motivation had an indirect effect on condoms use through behavioral skills,and behavioral skills had a direct impact on condoms use.The value of P=0.097>0.05 of information to motivation path,so information could not affect the condoms use behavior through behavioral skills.Motivation could affect guests support(β=0.552),peer support(β=0.119),infection crisis(β=-0.146)and personal attitude(β=0.359),which had a greater impact on guests support.Behavioral skills can affect self-efficacy(β=0.781)and personal self-control(β=0.399),which had a greater impact on self-efficacy.Therefore,the interventions of guests support,peer support,infection crisis,personal attitude,self-efficacy and personal self-control could change the condoms use behavior of OFSWs.According to the effect of 0.5 principle and submersible variables on condoms use behavior,the interventions of self-efficacy,guests support and personal self-control could better change condoms use behavior.4 Using SCM model to explore the influencing factors of OFSWs condoms useAccording to the SCM theory and the related researches to establish SEM and adjust it,but the final model was poor,we thought that the SCM theoretical model was not suitable for the exploration of the influence factors of condoms use among OFSWs.5 Using TPB model to explore the influencing factors of OFSWs condoms useIn the TPB model,perceptual control and intention had a direct effect on condoms use.The size of the effects were 0.672 and 0.220,and the behavioral norms had an indirect effect on condoms use with the effect being 0.091.The value of P=0.725>0.05 of attitude to condoms use path,so attitude could not affect the condoms use behavior.Perceptual control had impacts on personal,self-control(β=0.382)and self-efficacy(β=0.914),and behavioral norms could affect peer support(β=0.412)and guests support(β=0.0.293).the intention could affect the condoms use intention(β=0.492).Therefore,intervention on personal self-control,self-efficacy,peer support,guests support and intention to condoms use can change the condoms use behavior of OFSWs.According to the effect of 0.5 principles and submersible variables on the condoms use behavior,interventions on self-efficacy and personal self-control can better change the condoms use behavior.6 Comparison of the application of three models in OFSWs condoms useThe fitness indices of IMB model:χ2/df=2.433<3(n=420,df=8)comparative fit index(CFI)=0.941>0.90,Tacker-Lewis index(TLI)=0.903>0.90,goodness-of-fit(GFI)=0.973>0.90,adjusted goodness-of-fit index(AGFI)=0.945>0.90,root mean square error of approximation(RMSEA)=0.058<0.06(90%CI:0.039-0.079),the above model fitness indices how the model fitted well.The fitness indices of TPB model:3<χ2/df=4.659<5(n=420,df=8),CFI=0.943>0.90,TLI=0.900>0.90,GFI=0.968>0.90,AGFI=0.925>0.90,RMSEA=0.093>0.06(90%CI:0.070～0.119),the above model fitness indices showed a general model fitting effect.The fitness indices of SCM model:χ2/df=7.440>5(n=420,df=22),CFI=0.757<0.90,TLI=0.603<0.90,GFI=0.934>0.90,AGFI=0.866<0.90,RMSEA=0.124>0.06(90%CI:0.107～0.142),the above model fitness indices showed a poor model fitting effect.7 The attitude and behavior pattern of OFSWs’ condoms use with regulars and their influencing factors7.1 The attitude and behavior pattern of OFSWs’ condoms use with regularsA single latent variable model analysis was used to explore the attitude and behavior pattern of OFSWs condoms use with regulars in this research.1,2 and 3 latent class models were fitted respectively.Akaike information criterion(AIC)=1606.67,Bayesian Information Criterion(BIC)=1643,03,entropy=0.77.2 latent class model were better than those of 2 other fitness class models.According to the characteristics of OFSWs’ division,the 2 latent categories were named "positive contradiction type" and "negative consistency type" respectively,and the proportion of them was 12.62%and 87.38%.7.2 The influencing factors of the attitude and behavior pattern of OFSWs’condoms use with regularsχ2 test analysis showed that age(χ2=13.27,P=0.001),education(χ2=12.23,P=0.002),trading revenue(χ2=7.89,P=0.019),HIV knowledge(χ2=5.63,P=0.018),and drugs(χ2=4.03,P=0.045)were influencing factors of attitude and behavior patterns of OFSWs’ condoms use with regulars;logistic regression analysis showed that OFSWs of the age of 35～39(OR=3.47,95%CI=1.55～7.76)and 40～49(OR=3.47,95%CI=1.36～6.17),education of junior high school(OR=2.10,95%CI=1.05-4.19),(OR=4.21.95%CI=1.62～10.91)and HIV knowledge(OR=1.89,95%CI=1.01～3.53)were more likely to form a "positive contradiction type".Drug addicts of OFSWs(OR=0.34,95%CI:0.17-0.71)was more likely to form a "negative consistency type".Conclusions and suggestions1 Both IMB and TPB models indicated that self-efficacy and self-control were important preventive behavior for OFSWs’ condoms use.Therefore,interventions on self-efficacy and self-control should be the top priority.The relevant departments can enhance the awareness of condoms use and the self-control of OFSWs,and improve the confidence of the OFSWs persuading guests to use condoms by persuading the guests to use the condoms training.Guests support and peer support are also the factors affecting the condoms use.To promote the awareness of AIDS/STDs related knowledge and condoms use in key groups(such as truck drivers,single middle-aged and elderly people,etc.)and improve the awareness of the potential "guests" to use condoms.To strengthen peer education and promote the week group through the active people.2 The IMB model had the best adaptability in exploring prevention behaviors of OFSWs’ condoms use.It suggests that we should focus on the preventive behaviors in IMB model and try to use IMB model in OFSWs’ research.3 The attitude and behavior patterns of OFSWs’ condoms use with regulars could be divided into positive contradiction type and negative consistency type.In spite of the fact that the use of condoms was more active in positive contradiction type,there were still uncertainties in actual actions,and the reason for its uncertainty needs further exploration.Promoting the HIV knowledge at 50 years old,high school and higher education can help to improve the condoms use rate with their regulars. |
PDF Full Text Request