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AIDS Behav (2007) 11:393407 DOI 10.1007/s10461-007-9208-9
ORIGINAL PAPER
Using Theory to Understand How Interventions Work: Project RESPECT, Condom Use, and the Integrative Model
Fen Rhodes Judith A. Stein Martin Fishbein Ris B. Goldstein Mary Jane Rotheram-Borus
Published online: 24 February 2007 Springer Science+Business Media, LLC 2007
Abstract The Integrative Model of Behavioral Prediction (IM) provides guidelines for the development of successful HIV/STD interventions, yet few HIV prevention programs have identied which components of the IM have been associated with successful behavioral outcomes. Using structural equation modeling, this study examines in detail how components of the IM assessed prior to, and immediately after, the delivery of an intervention are associated with reported condom use 3 months later among participants in Project RESPECT, a multisite randomized controlled trial testing HIV/STD risk reduction strategies among clients attending public health clinics for sexually transmitted diseases. Overall, the IM predicted condom use at 3 months; there were, however, variations in the relative contribution of differing IM
components as a function of gender and type of sexual partner as well as the type of intervention the participant had received.
Keywords Condom use Theory of reasoned action Social cognitive theory Health belief model
HIV
Introduction
A large number of HIV prevention programs have successfully reduced HIV risk among heterosexuals (Rotheram-Borus, Cantwell, & Newman, 2000). Project RESPECT is one such successful intervention. In Project RESPECT, 5,758 patients recruited at ve public health clinics (Baltimore, MD; Denver, CO; Long Beach, CA; Newark, NJ; and San Francisco, CA) for sexually transmitted diseases (STDs) were randomized to one of four face-to-face intervention conditions:(1) a four-session Enhanced Counseling condition that was based on an Integrative Model (IM) (Fishbein, 2000; Institute of Medicine (IOM), 2002; National Academy of Science (NAS), 2002) that incorporated variables from the theory of reasoned action (Ajzen & Fishbein, 1980; Fishbein, 1967; Fishbein & Ajzen, 1975), the Health Belief Model (Becker, 1974), and social cognitive theory (Bandura, 1977; 1994; 1997); (2) a two-session Brief Counseling condition based in part on the Health Belief Model and Social Cognitive theory that reected best current practice in HIV test counseling (Centers for Disease Control and Prevention, 1993, 1994); Brief Counseling included both cognitive and action-oriented strategies to reduce risk; and (3) two comparison conditions in which 5-min