smoking in the short term), but safer sex is an ongoing behaviour, which requires an
ongoing determination to adopt condom use as a habit.
Sex is emotional and involves a level of high arousal: these factors may make the rational
information processing approach of the HBM redundant.
Sex is interactive and involves negotiation: condom use takes place between two people,
it involves a process of negotiation and occurs within the context of a relationship.
Assessing individual cognitions does not access this negotiation process. Abraham
and Sheeran (1993) suggest that social skills may be better predictors of safe sex.
From beliefs to behaviour: the HBM does not clarify how beliefs (e.g. ‘I feel at risk’) are
translated into behaviour (e.g. ‘I am using a condom’).The theory of reasoned action (TRA) and the theory of planned
behaviour (TPB)
In an attempt to resolve some of the problems with the HBM, the TRA and TPB have
been used to predict condom use. These models address the problem of how beliefs are
turned into action using the ‘behavioural intentions’ component. In addition, they
attempt to address the problem of placing beliefs within a context by an emphasis on
social cognitions (the normative beliefs component). Research suggests that the TRA has
had some degree of success at predicting condom use with behavioural intentions pre-
dicting condom use at one, three and four months (Fisher 1984; Boyd and Wandersman
1991; van der Velde et al. 1992). In addition, attitudes to condoms predict behavioural
intentions (Boldero et al. 1992), and perceived partner support (partner norms) appears
to be a good predictor of condom use by women (Weisman et al. 1991).
Research has also explored the relative usefulness of the TRA compared with the TPB
at predicting intentions to use condoms (Sutton et al. 1999). The results from this study
indicated that the TPB was not more effective than the TRA (in contrast to the authors’
predictions) and that past behaviour was the most powerful predictor. In a recent study
of condom use, the best predictors appeared to be a combination of normative beliefs
involving peers, friends, siblings, previous partners, parents and the general public.
This suggests that although cognitions may play a role in predicting condom use, this
essentially interactive behaviour is probably best understood within the context of both
the relationship and the broader social world, highlighting the important role of social
cognitions in the form of normative beliefs. Therefore, although TRA and TPB, address
some of the problems with the HBM, they still do not address some of the others.The role of self-efficacy
The concept of self-efficacy (Bandura 1977) has been incorporated into many models of
behaviour. In terms of condom use, self-efficacy can refer to factors such as confidence in
buying condoms, confidence in using condoms or confidence in suggesting that condoms
are used. Research has highlighted an association between perceived self-efficacy and
reported condom use (Richard and van der Pligt 1991), and a denial of HIV risk during
the contemplation of sex (Abraham et al. 1994). Schwarzer (1992) developed the health198 HEALTH PSYCHOLOGY