Department of Health, Free State, Bloemfontein, 9300, South Africa.
BMC Public Health. 2012 May 28;12:381. doi: 10.1186/1471-2458-12-381.
This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa.
Through a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT) were used for analysing two response variables 'ever used condom' and 'ever refused condom'.
Eighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by 'knowledge of correct use of condom', condom availability, young age, being single and higher education. 'Perceived need' for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one's HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms). In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables.
The use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms.
本研究调查了南非自由州省使用和拒绝使用避孕套的程度和预测因素。
通过在南非自由州省进行的一项家庭调查，对 5837 名成年人进行了访谈。使用单变量和多变量调查逻辑回归和分类树（CT）分析了两个因变量“曾经使用过避孕套”和“曾经拒绝使用避孕套”。
83%的受访者曾经使用过避孕套，其中 38%的人总是使用避孕套；61%的人在最近一次性交中使用了避孕套，9%的人曾经拒绝使用避孕套。单变量逻辑回归模型和 CT 分析表明，避孕套使用的一个强有力的预测因素是其被认为的必要性。在 CT 分析中，紧随其后的是“正确使用避孕套的知识”、避孕套的可获得性、年龄较小、单身和较高的教育程度。在控制了其他变量后，“对避孕套的需求”在多变量分析中不再是避孕套使用的显著预测因素。CT 显示，避孕套拒绝使用的最强预测因素是与避孕套相关的羞耻感，其次是存在性风险行为、了解自己的 HIV 状况、年龄较大以及缺乏避孕套知识（即预防性病和怀孕的能力、可用性、正确和一致的使用以及女用避孕套的存在）。在多变量逻辑回归中，年龄对于避孕套拒绝使用并不显著，而可负担性和被认为的必要性是其他显著的变量。
除了逻辑回归之外，使用补充建模技术，如 CT，可以更好地理解避孕套的使用和拒绝。进一步提高避孕套的正确和一致使用，需要有针对性的干预措施。除了现有的社会营销活动外，还应采取有针对性的方法，重点建立对避孕套使用的需求，并提高正确使用的技能。还应包括减少与避孕套相关的羞耻感的干预措施，以及对可能拒绝使用避孕套的人进行个别咨询。
