Integrating developmental and decisionmaking approaches to contraception use

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192 HEALTH PSYCHOLOGY
According to the sexual behaviour sequence model, decisions about contraception are
made in the context of both rational information processing and emotions. This model
attempts to add a degree of emotions and social norms (from the TRA) to the individual’s
cognitions.
Herold and McNamee’s (1982) model
This model is made up of the following variables: (1) parental and peer group norms for
acceptance of premarital intercourse; (2) number of lifetime sexual partners; (3) guilt
about intercourse and attitudes to contraception; (4) involvement with current partner;
(5) partner’s influence to use contraception; and (6) frequency of intercourse. This
model differs from other models of contraception use as it includes details of the relationship. It places contraception use both within the general context of social norms and also
within the context of the relationship.
In summary
These decision-making models regard contraceptive use as resulting from an analysis of
the relevant variables. However, they vary in the extent to which they attempt to place
the individual’s cognitive state within a broader context, both of the relationship and the
social world.
Integrating developmental and decision-making approaches
to contraception use
Developmental models emphasize behaviour and describe reliable contraception use as
the end product of a transition through a series of stages. These models do not examine
the psychological factors, which may speed up or delay this transition. In contrast,
decision-making models emphasize an individual’s cognitions and, to a varying degree,
place these cognitions within the context of the relationship and social norms. Perhaps
these cognitions could be used to explain the behavioural stages described by the
developmental models. Sheeran et al. (1991) argued that these perspectives could be
combined and that the best means to examine contraceptive use is as a product of
(1) background; (2) intrapersonal; (3) interpersonal; and (4) situational factors. They
defined these factors as follows:
Background factors
1 Age: evidence suggests that young women’s contraceptive use increases with age
(e.g. Herold 1981).
2 Gender: women appear to be more likely to use contraception than men (e.g. Whitely
and Schofield 1986).
3 Ethnicity: some evidence suggests that whites are more likely to use contraception
than blacks (e.g. Whitley and Schofield 1986).
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SEX
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4 Socio-economic status: there is conflicting evidence concerning the relationship
between SES and contraceptive use with some research indicating a relationship
(e.g. Hornick et al. 1979) and others indicating no relationship (e.g. Herold 1981).
5 Education: evidence indicates that higher school performance and higher educational aspirations may be linked with contraception use (e.g. Herold and Samson
1980; Furstenburg et al. 1983).
Although these background factors may influence contraceptive use, whether this effect
is direct or through the effect of other factors such as knowledge and attitudes is unclear.
Intrapersonal factors
1 Knowledge: Whitley and Schofield (1986) analysed the results of 25 studies of
contraceptive use and reported a correlation of 0.17 between objective knowledge
and contraceptive use in both men and women, suggesting that knowledge is poorly
linked to behaviour. Ignorance about contraception has also been shown by several
studies. For example, Cvetkovich and Grote (1981) reported that of their sample
10 per cent did not believe that they could become pregnant the first time they had
sex, and 52 per cent of men and 37 per cent of women could not identify the periods
of highest risk in the menstrual cycle. In addition, Lowe and Radius (1982) reported
that 40 per cent of their sample did not know how long sperm remained viable.
2 Attitudes: Fisher (1984) reported that positive attitudes towards contraception
parallel actual use. Negative attitudes included beliefs that ‘it kills spontaneity’, ‘it’s
too much trouble to use’ and that there are possible side effects. In addition, carrying
contraceptives around is often believed to be associated with being promiscuous
(e.g. Lowe and Radius 1982).
3 Personality: Many different personality types have been related to contraceptive
use. This research assumes that certain aspects of individuals are consistent over time
and research has reported associations between the following types of personality:
I conservatism and sex role have been shown to be negatively related to contraceptive
use (e.g. Geis and Gerard 1984; McCormick et al. 1985).
I an internal locus of control appears to correlate with contraceptive use but not with
choice of type of contraception (Morrison 1985).
I sex guilt and sex anxiety positively relate to use and consistency of use of
contraception (Herold and McNamee 1982).
Interpersonal factors
Research highlights a role for characteristics of the following significant others:
1 Partner: facets of the relationship may influence contraception use including
duration of relationship, intimacy, type of relationship (e.g. casual versus steady),
exclusivity, and ability to have overt discussions about contraception (e.g. DeLamater
and MacCorquodale 1978, 1979).
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