Introduction: SCT is an interpersonal theory that explains human behaviour as a three-way relationship
between personal factors, environmental factors and their behavioural factors (Bandura, 1989). The
theory identifies self-efficacy and outcome expectations as part of the five key determinants of
behaviour. Condom use still remains one of the most popular forms of HIV prevention, however its
effectiveness depends on whether it is used consistently or not. The overall aim of the study was to
determine whether condom self-efficacy and outcome expectations are associated with consistent
condom use among sexually active 18-34 year olds in Botswana in 2010.
Materials and Methods: The study design was a quantitative secondary analysis of nationallyrepresentative
cross-sectional survey collected by the PSI Botswana’s Condom Social Marketing TRaC:
Tracking Results Continuously, 2010 survey (herein, TRaC). The study population for TRaC was men and
women aged 18-34 years old in Botswana who reported being sexually active in the past 12 months and
were not practicing abstinence when recruited in 2010. The sample size was 1299 which was randomly
selected from 96 enumeration areas (EAs).
Results: Self-efficacy to use condoms was positively associated with consistent condom use, while
overall condom self-efficacy and self-efficacy to negotiate condom use were not associated with
consistent condom use. Social outcome expectations and pleasure outcome expectation were also
associated with consistent condom use, although overall outcome expectations and those related to
health were not associated with consistent condom use. Males significantly reported significantly lower
expectations of pleasure than females. That said, female were significantly less likely to use condoms
consistently and some aspects of their self-efficacy and outcome expectations were worse than males,
which also was reflected in measures of socio-demographic disadvantage.
Conclusions: Overall the study showed that a high percentage of 18-34 year olds in Botswana in 2010
used condoms consistently regardless of their socio-demographic profile or the sexual partner type.
Also, encouragingly, a high percentage of 18-34 year olds in Botswana had either moderate or positive
condom self-efficacy as well as positive output expectations of condom use. The two constructs of SCT
were inconsistent in predicting consistent condom use, which suggests that measures for the constructs
must be refined and supplemented with additional explanatory variables. Some constructs can assist
health communication practitioners. For instance, the findings suggest that messages the support the
notion that sex can be pleasurable with a condom should be targeted towards both sexes, rather than
primarily focusing on the health benefits. The lack of self-efficacy to use condoms also needs to be
addressed, as well as the need for more messages that portray social support for condom use. Beyond
SCT, the findings indicate, there needs to be further research on the specific gender differences in
condom use patterns and condom promotion campaigns should produce gender-sensitive messaging.