The role of planning and self-efficacy in condom use among men who have sex with men: an application of the Health Action Process Approach model

Objective: In Hong Kong, men who have sex with men (MSM) remain a high risk group for HIV infection. This study applied the Health Action Process Approach (HAPA) to study the motivational and behavioral patterns of local MSM in condom use.

Design: Four hundred ten sexually active MSM completed the questionnaire on site at Time 1; 217 who remained sexually active were interviewed during a 1-month follow-up.

Main outcome measures: Risk perception, outcome expectancy, action self-efficacy, intention, planning, maintenance self-efficacy, and recovery self-efficacy were measured at Time 1. Actual condom use was measured at both time points.

Results: The HAPA model had a good fit to the data (χ2 = 300.71, df = 111, p < .001, CFI = .95, NNFI = .93, RMSEA = .065). Time 2 condom use was predicted by Time 1 planning, maintenance self-efficacy, and intention, which, in turn, was predicted by action self-efficacy, outcome expectancy, and risk perception. Planning mediated the association between intention and actual condom use. No group difference between MSM partners of different sex roles was found.

Conclusion: It is demonstrated that the HAPA model could be applied to understand safer sex behavior among Chinese MSM. Its principles can help develop HIV prevention programs targeting safer sex practices by MSM.