[Proposal] Why do people differ in their sexual health behaviors? A motivational approach to understand risk perception and safer sex practices

A. Background/ Overview of Research

Consistent (and efficient) condom use is highly effective in preventing new sexually transmitted infections (STIs; UNFPA et al., 2015) and yet, many people abstain from using condoms and are at risk of acquiring sexually transmitted infections (STIs; e.g. Copen, 2017). Indeed, STIs remain a significant public health concern (Rowley et al, 2019), with recent reports showing increasing rates of STIs and condomless sex practices in adults (e.g., Moreno et al., 2019; Reis et al., 2018).

People motivated by security (vs. pleasure) take fewer risks with their health and safety (Zou & Scholer, 2016) and believe they have more control over their behaviors (e.g., Lemarié et al., 2019). Extending this to sexual health, we found that people who were single and focused on security perceived more threats to their health, had stronger intentions to use condoms with casual partners (Rodrigues et al., 2019), were more likely to have used condoms with them (Rodrigues et al., 2020), and perceived to have greater control over condom use (Rodrigues et al., 2021). People who were single and focused on pleasure were less likely to have use condoms with casual partners (Rodrigues et al., 2020) and had stronger intentions to get tested for STIs (Rodrigues et al., 2021).

We will examine if motives for security and pleasure are distinctively associated with reasons to use condoms (e.g., condoms as protection STIs or as a contraceptive method) and knowledge and beliefs about sexually transmitted infections (STIs). Overall, we expect people more focused on security (vs. pleasure) to endorse more reasons to use condoms (H1) and have more knowledge about STIs and the implications of contracting STIs for sexual health (H2).

B. Methodology

Procedure

This study is part of the Prevent2Protect project (OSF | Prevent2Protect: Motivational determinants of consistent condom use). All data will be collected online using Qualtrics online platform, and the survey will have an estimated duration of 15 minutes.

Participants will be recruited via Prolific Academic and will be monetarily reimbursed for their time. To be eligible, participants must provide their consent, have at least 18 years of age, have previously engaged in sexual activity, and be currently single and not romantically involved with a significant other.

Measures

No questions will be mandatory, and participants will have the option to complete the survey without providing their answers. We will measure the following measures:

Regulatory Focus in Sexuality

We will assess security (three items; e.g., “Not being careful enough in my sex life has gotten me into trouble at times”) and pleasure motives in sexuality (six items; e.g., “I am typically striving to fulfill my desires with my sex life”). Responses will be given on 7-point rating scales (1 = Not at all true of me to 7 = Very true of me ; Rodrigues et al., 2019).

Situations Related to Condom Use

Participants will be asked to list situations in which people are more likely to have condomless sex [ open-ended question ], and situations in which people are more likely to use condoms [ open-ended question ]. We will conduct a thematic analysis and categorize responses into major themes.

STI Knowledge and Beliefs

Participants will be shown a list of STIs (e.g., Syphilis; Trichomoniasis). For each STI, they should indicate if they know of/heard about the STI (1 = I’ve never heard about this STI ; 2 = I’ve heard about this STI, but I have no knowledge about it ; 3 = I have specific knowledge about this STI ), have been tested for each (1 = No ; 2 = Yes ; 3 = Don’t know ), were diagnosed with each (1 = No ; 2 = Yes ), and how frequently people should get tested for each STI (1 = Once a year to 7 = After each new casual partner ). When participants indicate to have knowledge about STIs (response “3” to the first question), they will be asked to share their knowledge (e.g., way of transmission, typical symptoms, and treatment [ open-ended question ]) and where they got this information ( same-sex friends, different-sex friends, parents, family practice doctor, family planning consultations, STIs Screening Tests, Internet, or Other sources ). We will conduct a thematic analysis and categorize knowledge and sources of information into major themes.

We will explore if demographic variables (e.g., age, gender, sexual orientation) moderate our findings and if past STI diagnoses shape the knowledge people have about STIs.

Sample size

The sample size was determined using the most conservative design to test our hypotheses (H2). We will compute a mixed repeated-measures ANOVAs with three between-participants conditions (regulatory focus categorization: predominant focus on security vs. no predominant focus vs. predominant focus on pleasure) and five within-participants variables (see STI Knowledge and Beliefs section).

Considering a medium effect size (f = .10) and 95% power, G*Power (Faul et al., 2007), we will need at least 561 participants. Sample size estimations will be increased by 30% to account for incomplete data or participants who do not meet inclusion criteria, resulting in a target sample of 730 participants.

Study costs

Each participant will receive £3.5 upon survey completion. Considering our sample of 730 participants (equally split by gender), 33% service fee, and 20% VAT, we are asking for £3,600.

C. Data and dissemination

Reflecting our commitment to open science and rigorous research, we pre-registered our hypotheses and analytic plan on OSF. All materials and data will be made available on our main page: OSF | Prevent2Protect: Motivational determinants of consistent condom use.

Preprints of scientific articles will be shared on PsyArXiv. Final publications and other relevant documents related to the project will be shared on our OSF page and to our ResearchGate profiles. Scientific articles will be Open Access to be widely disseminated and freely available for the community

D. Expected contribution and impact

The project can contribute to current theoretical and social debates regarding condom use and sexual health, increase condom use and sexual health check-up rates, as well to foster sexual health and well-being among young adults.

Thank you for your interest!