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Decisionmaking models

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Decisionmaking models
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190 HEALTH PSYCHOLOGY
Rains’s model
This model was developed by Rains (1971) and again places contraception use within
the context of sexuality and self-concept. It suggests that contraception use is more likely
to occur at a stage when the individual believes that sexual activity is ‘right for them’.
This process involves the following four stages:
1 Falling in love: this provides a rationale for sex.
2 Having an exclusive, long-term relationship.
3 Sexual intercourse becomes an acceptable behaviour.
4 Individuals accept themselves as sexual and plan sex for the future.
According to this model, reaching stage 4 predicts reliable contraception use.
Decision-making models
Decision-making models examine the psychological factors that predict and are the
precursors to contraception use. There are several different decision-making models and
they vary in their emphasis on individual cognitions (e.g. costs and benefits of contraception use) and the extent to which they place these cognitions within the specific
context of the relationship (e.g. the interaction, seriousness of relationship, frequency
of sexual intercourse in the relationship) and the broader social context (e.g. peer norms,
social attitudes).
Subjective expected utility theory
Most decision-making models of behaviour are based on the subjective expected utility
theory (SEU) (Edwards 1954). The SEU predicts that individuals make subjective
estimates of the possible costs and benefits of any particular behaviour and, based on
this assessment, make a decision as to which behaviour results in the least costs and the
most benefits (material, social and psychological). It therefore characterizes behaviour
as rational. Luker (1975) examined the SEU in the context of contraceptive use and
argued that individuals weigh up the costs and benefits of pregnancy against the costs
and benefits of contraception. Sheeran et al. (1991) argued that this approach was
important as it undermined the belief that contraception has no costs for women and
pregnancy had no benefits. The SEU is predominantly individualistic and the role of both
the relationship and social context is minimal.
The five-component model
This model was developed by Reiss et al. (1975) and, although it still regards contraceptive use as resulting from a rational appraisal of the situation, it includes measures
of more general attitudes. The components of the model are: (1) endorsement of sexual
choices (e.g. permissiveness, religiosity); (2) self-assurance; (3) early information on
sex and contraception; and (4) congruity between premarital sexual standards and
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behaviour and commitment. Reiss et al. tested the model and reported support for
the first three of the variables as predictive of contraception use. This model is still
predominantly concerned with individual cognitions.
The health belief model
This model was developed by Rosenstock and Becher (e.g. Rosenstock 1966; Becker and
Rosenstock 1987) and is described in detail in Chapter 2. The original HBM emphasized
individual cognitions and ignores the problem of interaction. Lowe and Radius (1982)
developed the HBM specifically to predict contraception and aimed to examine individual
cognitions within both the context of the relationship and broader social norms. They
added the following variables:
I self-esteem;
I interpersonal skills;
I knowledge about sex and contraception;
I attitudes to sex and contraception;
I previous sexual, contraceptive and pregnancy experiences;
I peer norms;
I relationship status; and
I substance use prior to sex.
Therefore, although this model still examines cognitions, it includes measures of the
individuals’ cognitions about their social world.
The theory of reasoned action
This theory was developed by Fishbein and Ajzen (1975) and is described in detail in
Chapter 2. The TRA was the first cognition model to include measures of individuals’
cognitions about their social world in the form of subjective norms. It therefore
represents an attempt to add the social context to individual cognitive variables and
consequently addresses the problem of interaction. The TRA has been used to predict
contraceptive use and research has indicated a correlation between the components of
the model and intentions to use the oral contraceptive (Cohen et al. 1978). In addition,
research by Werner and Middlestadt (1979) reported correlations between attitudes to
contraception and subjective norms and actual use of oral contraception.
Sexual behaviour sequence model
This model was developed by Byrne et al. (1977) and adds sexual arousal and emotional
responses to sex to the factors included in the TRA. Sexual arousal refers to how aroused
an individual is at the time of making a decision about contraception. Emotional
responses to sex describes a personality trait that Byrne et al. defined as either erotophilia (finding sexual cues pleasurable) or erotophobia (finding sexual cues aversive).
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