Body dissatisfaction and condom use self-efficacy: A meta-analysis

Highlights

• Body dissatisfaction and condom use self-efficacy were explored.

• Data were from 2495 participants across 11 studies.

• Meta-analytic results revealed r = −.25, Cohen's d = −0.52.

• As body dissatisfaction increases, condom use self-efficacy decreases.

Abstract

The consistent use of condoms is the most effective behavior for reducing the acquisition of sexually transmitted infections (STIs), and condom use self-efficacy has been shown to be a key construct related to condom use. However, the examination of modifiable psychosocial and behavioral correlates of condom use self-efficacy is lacking. Recent investigations have highlighted the association of body dissatisfaction with condom use self-efficacy, and the current study conducted a meta-analysis on all available data addressing this relationship. Eleven individual effect-size parameters from nine studies yielded a total sample of 2495 men and women participants. A random-effects model revealed an average effect-size of r = −.25, Cohen's d = −0.52, which is moderate in strength. As body dissatisfaction increases, ones’ self-efficacy regarding the use of condoms diminishes. Integrating interventions to decrease body dissatisfaction and sexual risk behaviors may prove to be an effective strategy to decrease STIs.

Introduction

Safer sexual practices, such as consistent condom use, are important preventative measures against the spread and transmission of sexually transmitted infections (STIs), yet less than half of U.S. adults use condoms during sex with non-regular partners (e.g., Anderson, 2003). There is ongoing evidence that efforts to promote consistent condom use in the U.S. are needed, in that the rates of new HIV infections have not decreased in the past decade (CDC, 2013), and that the prevalence of STIs is estimated at 110 million in the U.S., with roughly 20 million new infections per year (Satterwhite et al., 2013). Accordingly, studies examining psychosocial and behavioral variables that can be modified and reduce HIV and STI acquisition are still needed, as traditional efforts are not achieving their goals (e.g., Crepaz et al., 2006, Herbst et al., 2007).

Use of condoms operates in conjunction with psychosocial variables. Condom use self-efficacy, defined as confidence in one's ability to practice safer sex in difficult situations, is one variable that has been featured prominently in many models of health behaviors, such as social cognitive theory (Bandura, 1994). This theory, applied to safer sex behaviors, proposes that individuals engage in a process of evaluating the relative advantages and disadvantages of using condoms during sex (e.g., social norms of condom use, knowledge about STIs, and expectancies regarding condom use). These cognitive processes subsequently predict one's level of self-efficacy. Self-efficacy then becomes the salient variable in terms of whether an individual engages in unprotected vs. safer sex practices. Empirically, self-efficacy has been strongly related to actual use of condoms among a variety of populations (e.g., Baele et al., 2001, Wulfert et al., 1999, Wulfert and Wan, 1993, Wulfert et al., 1996), and meta-analytic data have revealed medium-sized effects with actual condom use for both cross-sectional and longitudinal studies (Sheeran, Abraham, & Orbell, 1999). One study compared social cognitive theory, with self-efficacy, to the two other most frequently used theories related to condom use, the health belief model and theory of reasoned action (Wulfert et al., 1996). Results indicated that self-efficacy explained variance in condom use above and beyond that accounted for by the other two models, highlighting its value in promoting safer sex behaviors.

Although condom use self-efficacy has been established as a salient predictor of condom use, proposed psychosocial variables that might contribute to condom use self-efficacy have been limited. One construct that has recently received increased attention in this area is body dissatisfaction. Body dissatisfaction may be defined as possessing negative evaluation about one's body or appearance (Cash, 2002). Theoretically, it has been argued that elevated body dissatisfaction may be associated with lowered condom use self-efficacy. Individuals who have concerns regarding their appearance report heightened worry about receiving negative evaluations from others (e.g., Cash, Thériault, & Annis, 2004). In the context of sexual behaviors, where exposed bodies are central, engaging in discussions regarding condom use may lead individuals with body dissatisfaction to experience increased anxiety, perhaps concerned that this negotiation with sexual partners will lead to rejection. Thus, individuals with elevated body dissatisfaction may lack assertiveness in broaching the use of condoms, and may be less likely to initiate conversation around safer sex practices.

Empirically, a number of studies have found significant relationships between body dissatisfaction and lowered condom use self-efficacy. Most of these studies sampled adolescent or young adult women (i.e., Gillen et al., 2006, Salazar et al., 2004, Schooler et al., 2005, Swenson, 2007, Van Anders, 2013, Watson et al., 2013, Weaver and Byers, 2006, Yamamiya et al., 2006). Comparably fewer studies have assessed these relationships among men (for exceptions, see Blashill et al., 2014, Gillen et al., 2006, Van Anders, 2013). Of those, Blashill et al. (2014) sampled men who have sex with men (MSM) living with HIV, and found a medium-sized effect between body dissatisfaction and lower condom use self-efficacy. The limited studies on heterosexual men have revealed conflicting results, with Gillen et al. (2006) finding a null result, and others noting a significant medium-sized effect (Schooler and Ward, 2006, Van Anders, 2013). Thus, it would seem that the relationship between body dissatisfaction and condom use self-efficacy has been less consistently studied among men as compared to women.

To date, there has been limited empirical examination of psychosocial predictors of condom use self-efficacy, the key predictive variable in social cognitive theory. Body dissatisfaction is prevalent among men and women (24–32% for men and 35–38% for women; Peplau et al., 2009), and emerging data have begun to reveal significant associations with condom use self-efficacy. However, to our knowledge, there have been no attempts to integrate the data on this topic to yield a summary of the significance and size of the effect of body dissatisfaction on condom use self-efficacy. Thus, the aim of this study was to conduct a meta-analysis on all available, published and unpublished, data on body dissatisfaction and condom use self-efficacy among men and women. It was hypothesized that a significant inverse relationship would be revealed between body dissatisfaction and condom-use self-efficacy. Although there are limited data to guide directional hypotheses, a preliminary moderation analysis was also conducted, examining the differential effect of participant sex on body dissatisfaction and condom use self-efficacy.