Background: Sub-Saharan African nations continue to carry the substantive burden of the HIV pandemic, and therefore, condom use promotion is a public health priority in that region. To be successful, condom promotion interventions need to be based on appropriate theory.
Objective: To develop and test an integrated theory of the determinants of young peoples’ condom use in Sub-Saharan Africa, using meta-analytic path analysis.
Method: Theory development was guided by summary frameworks of social-cognitive health predictors, and research predicting condom use in SSA, adopting social-cognitive theories. Attitudes, norms, control, risk perceptions, barriers to condom use, intentions, and previous condom use, were included in our condom use model. We conducted an exhaustive database search, with additional hand-searches and author requests. Data were meta-analyzed with Hedges and Vevea’s (1998) random-effects models. Individual, societal, and study-level parameters were assessed as candidate moderators. Included studies were also critically appraised.
Results: Fifty-five studies (N = 55,069), comprising 72 independent data sets, and representing thirteen Sub-Saharan African nations, were meta-analyzed. Statistically significant corrected correlations were obtained among the majority of the constructs included and of sufficient size to be considered non-trivial. Path analyses revealed (a) significant direct and positive effects of attitudes, norms, control, and risk perceptions on condom use intentions, and of intention and control on condom use; and (b) significant negative effects of perceived barriers on condom use. The indirect effects of attitudes, norms, control, and risk perceptions on condom use, mediated by intentions, were also obtained. The inclusion of a formative research component moderated eight of the 26 effect sizes. The majority of studies (88%) were of questionable validity.
Conclusion: Our integrated theory provides an evidence-based framework to study antecedents of condom use in Sub-Saharan African youth, and to develop targets for effective condom promotion interventions.