基于计划行为理论的暗娼人群安全套使用影响因素分析

  目的  研究湖北省不同档次场所暗娼（female sex workers，FSWs）安全套使用的影响因素。  方法  基于计划行为理论（theory of planned behavior，TPB）抽查湖北省六市的816名FSWs进行问卷调查，应用结构方程模型分析不同档次场所FSWs在商业性行为中安全套使用的影响因素。  结果  低档场所FSWs最近1次和最近1月商业性行为中安全套使用率均低于中高档场所FSWs（t=5.80，P < 0.001）。不同场所FSWs的TPB评分差异有统计学意义，低档场所FSWs知觉行为控制评分（11.43±2.86）低于中高档场所FSWs（12.06±2.87）（t=3.07，P=0.002）；但行为意图评分（5.47±1.11）高于中高档场所（5.20±1.15）（t=3.35，P=0.001）。知觉行为控制是低档场所FSWs使用安全套的最强影响因素（路径系数为0.55，P < 0.001），而安全套使用意图是中高档场所FSWs使用安全套的最强影响因素（路径系数为0.33，P < 0.001）。对于所有研究对象，安全套使用态度是安全套使用意图的最强影响因素（路径系数为0.49和0.42，P < 0.001）。  结论  提高FSWs对安全套的使用态度是提高FSWs安全套使用意图的重要举措。对于低档场所FSWs，应提高知觉行为控制相关因素；对于高档场所FSWs，应提高其安全套使用意愿。

Predictors related to condom use behaviors based on the theory of planned behavior among female sex workers

  Objective  To identify predictors related to condom use in different tiered female sex workers (FSWs) in Hubei Province.  Methods  A cross-sectional study was conducted in Hubei Province in 2015 to investigate 816 eligible FSWs by using a multistage sampling method. All data were collected by using a structured questionnaire with scales on condom use, which was designed based on the theory of planned behavior (TPB). A structural equation model (SEM) was used to identify predictors of condom use in the different tiered FSWs.  Results  It showed that low-tier FSWs used less condom than higher-tier FSWs in commercial sexual behaviors of the last time and during the last month(P < 0.001). The TPB scores were significantly different in different tiered FSWs. The scores of PBC in low-tier FSWs were lower than those in higher-tier FSWs (11.43±2.86 vs 12.06±2.87, respectively, P=0.002); But the scores of behavioral intentions were higher than those in higher-tier FSWs (5.47±1.11 vs 5.20±1.15, respectively, P=0.001). The PBC was the major factor related to condom use in low-tier FSWs (effect coefficient=0.55, P < 0.001), while the behavioral intention was the major factor related to condom use in higher-tier FSWs (effect coefficient=0.33, P < 0.001). Behavioral attitude was the major factor of intention to use condoms for both low-tier (effect coefficient=0.49, P < 0.001) and higher-tier FSWs (effect coefficient=0.42, P < 0.001).  Conclusions  Changing the attitude to condom use in FSWs is an important measure to promote the behavior intention. Condom promotion interventions should focus on the perceived behavioral control in low-tier FSWs, and promote the behavior intention in higher-tier FSWs.