Knowledge-behavior gap in condom use to prevent HIV infection: a case study of Ethiopian urban youth.

Abstract

Why are there low levels of condom use in a population that lives in an area with high HIV prevalence and that has knowledge about protective nature of condoms? This incongruity between knowledge of the effectiveness of condoms as a measure to protect from HIV infection and lack of condom use is the issue examined in this thesis. Specifically, a study of Ethiopian youth suggests that the gap between knowledge, attitude, and practice (KAP-gap) is present because knowledge of the benefits of a behavior is necessary but not sufficient to elicit behavioral intent. This thesis proposes that condom use self-efficacy is needed to translate knowledge into behavioral intent. A multi-method approach was used by first reviewing published research to determine levels of condom use self-efficacy among Ethiopian youth. Next, a qualitative analysis of 162 Ethiopian print health communication materials was conducted to determine presence of condom use self-efficacy in extant media material. This study found low self-efficacy to be an explanation for the condom use knowledge-behavior gap among urban Ethiopian youth. In addition, health messages available to urban youth in Ethiopia incorporated few self-efficacy messages. The study confirmed that knowledge is not enough to move people to behavior change. For health messages to be effective in increasing condom use behavior among this population, the salient predictors of condom use behavior identified using behavioral theory along with messages that increase condom use self-efficacy need to be incorporated into educational interventions.