Instant messaging sexual health intervention for emerging adults in Hong Kong : understanding perceptions of condom use and promoting safer sex practices

Abstract

Sexual health is fundamental to the overall health and well-being of individuals. Sexual health-related issues can be extensive, including topics ranging from sexual orientation and relationships to negative consequences, such as sexually transmitted infections (STIs) and unintended pregnancy. Emerging adults are at risk of contracting STIs and engaging in risky sexual behaviours due to a combination of biological, logical, and behavioural reasons. Additionally, Chinese culture is relatively conservative about sexual health issues when comparing to the Western counterparts, which further hinders Chinese emerging adults’ access to comprehensive sexual health information and care.

In recent years, interactive instant messaging (IM) interventions have been developed to improve various health behaviours. However, no study has evaluated the effectiveness of a personalised IM-based intervention to encourage consistent use of condom use, which is crucial for the primary prevention of STIs. This thesis aims to report the potential and effectiveness of an interactive IM intervention for promoting safer sex practices among emerging adults in Hong Kong. Perceptions on the use of condoms among emerging adults and improvements to the IM intervention were also explored.

A feasibility study comprising a 30-minute adaptive sexual health IM intervention via WhatsApp was conducted. Twenty-one Hong Kong emerging adults aged 18 to 29, with prior sexual experience, were recruited from local universities. The condom use consistency, changes in condom use attitude and knowledge, and acceptability of the intervention were investigated. Paired-sample t-test showed significantly increased total mean scores for condom use attitude and knowledge measured by the Multidimensional Condom Attitudes Scale (MCAS) (t = 3.727, p = 0.001), but not for the condom use consistency (Z = -1.41, p = 0.16).

In order to improve the content and delivery of the personalized IM intervention, the experiences and perceptions of condom use among the Chinese population have to be further examined. Hence, a mixed-method study was conducted to obtain a more comprehensive understanding of the complex factors influencing emerging adults' condom use behaviours. This study allowed for an exploration of the various factors associated with condom use consistency by triangulating qualitative and quantitative data, which provide a more nuanced understanding of the issues. Phase 1 involved an online questionnaire assessing condom use knowledge, attitude, self-efficacy, and consistency. Phase 2 included semi-structured interviews to explore factors associated with condom use behaviors. Multiple linear regression found that participants who were single, lived on campus, and were moderate drinkers were negatively associated with condom use variables. Mediation analysis showed a complementary partial mediating role of condom use attitude and self-efficacy in the relationship between condom use knowledge and condom use consistency. Phase 2 results identified four main themes: (1) Impacts of sexually transmitted infections and unintended pregnancy, (2) Socio-cultural expectations and implications on sexual behaviours and condom use, (3) Views on sexual behaviours and condom use, and (4) Barriers to condom use. This study highlighted that gender norms, social stigma, and cultural differences can influence condom use behaviours in Chinese emerging adults. Future research should consider these factors for developing effective public health interventions and policies.