AIDSQuest: The HIV/AIDS Survey Library
HIV Research Domains: Topic G Psychosocial Factors (selected)

Overview
In addition to HIV-related knowledge and attitudes, which are addressed in other sections, a number of other psychosocial factors are important determinants of HIV-related behaviors. Issues include perception of HIV risk, the confidence to insist on condom use (self-efficacy), and the intention to practice safe sex. All of these factors are important components of many commonly used theories that attempt to explain behaviors, and in practice, have been found in studies to be associated with HIV risk and prevention behaviors. In addition, HIV programs often attempt to influence these factors as the main goal of the program. Some of the more important of these psychosocial factors are addressed below, including HIV-related intentions, risk perceptions, self-efficacy, and stage of change.

Measurement issues
Each of the psychosocial factors is somewhat theoretically different, and questions about each factor are asked in specific ways. Depending upon the goals of the survey, one or all of the psychosocial factors can be addressed. If the goal of an HIV prevention program is to help women develop condom negotiation skills, for example, questions addressing this ability should be asked, particularly related to self-efficacy about condom negotiation.

Behavioral intentions are most often measured by a direct question about the likelihood of a person enacting a behavior. For example: "Do you intend to use a condom the next time that you have sex?"

Self-efficacy can be defined as the confidence a person feels about performing a specific behavior. This includes the confidence to overcome barriers to performing the behavior. For example, "How confident are you that you can successfully  insist on condom use the next time that you have sex?"

HIV risk perception can be defined as the respondent's opinion of their chances of getting HIV. It is usually asked in a direct way. For example, "How likely is it that you will get HIV?" Questions sometimes ask about the perception of past risk, current risk, and future risk.

The concept of "stages of change" addresses the fact that people often go through a variety of preparatory stages before they will enact a behavior, such as reducing their number of sexual partners. Typically, 5 separate stages are considered:

1. Precontemplation: when the person has no intention of making any changes of their behavior in the foreseeable future.

2. Contemplation: when someone is thinking of or intending to make a change in the foreseeable future.

3. Preparation: the stage when people intend to make action in the immediate future.

4. Action: when people have made specific behavior modifications within a recent time frame.

5. Maintenance: when someone has made behavioral changes for a longer period of time, and is working to prevent a relapse to their original behavior.

Typical HIV-related questions include: "Have you changed your behaviors because of HIV in the past month?" and if yes, "Which ones?"

As with other types of questions, it is important to keep comparability in mind when designing a survey. This is especially true if you are going to ask similar questions within the same survey, collect more than one round of data (e.g., pre-and post-tests), or if you will want to compare your results to other studies. For example, self-efficacy questions can be asked in different ways:

"I feel confident that I can insist on condom use the next time that I have sex." 

"I feel confident that I can insist on condom use."

"I feel confident that I can insist on condom use, even if my partner doesn't want to use a condom."

The meaning of each statement is different, and responses to each could not be directly compared. Examples of questions relating to these psychosocial factors have been selected from the following questionnaires:

1. Intentions

• Horizons—Female Condom User Study
• AIDSCAP/WHO/CAPS—Voluntary Counseling and Testing Efficacy Study (Baseline Instrument)
• UCSF CAPS—Condom Use Among Hispanics

2. Risk perception

• Horizons—STI/HIV Intervention Among Miners and Sex Workers in Carletonville
• Horizons—Transition to Adulthood in the Context of HIV/AIDS
• Horizons—Testing Clinic- and Community-based Strategies for Reducing Mother-to-Child Transmission of HIV
• AIDSCAP/WHO/CAPS—Voluntary Counseling and Testing Efficacy Study (Baseline Instrument)

3. Self-efficacy

• Horizons—Evaluating the Impact of HIV Prevention Programs in Schools
• UCSF CAPS—Condom Use Among Hispanics
• Population Council—RAPIDS Baseline Survey: Questions for youth aged 15-18

4. Stages of change

• Horizons—STI/HIV Intervention Among Miners and Sex Workers in Carletonville
• AIDSCAP/WHO/CAPS—Voluntary Counseling and Testing Efficacy Study (Baseline Instrument)