This chapter gives the rationale and conceptual defense for the Systematic

No abstract

A framework of the relationship between knowledge, attitudes, and behavior was described in the context of couple's use of birth control. It was hypothesized that when knowledge of behavioral enactment is present, attitudes and beliefs about susceptibility to pregnancy will be predictive of accurate use of the diaphragm. Respondents were 111 women who participated in a three-wave panel design focusing on diaphragm use. Analyses indicated that the level of knowledge about what a woman should do to use the diaphragm correctly was high. Correct knowledge, however, did not translate into accurate behavior. Motivational factors focusing on attitudes, perceived susceptibility to pregnancy, and normative factors were also relevant.

A field evaluation with repeated measures at 6 and 12 months on an intent-to-treat sample of 529 women conducted in 11 selected sites across the country. There were significant improvements shown in substance use and family and social functioning by the 6-month point, and additional improvements in employment by the 12-month point. By 12 months, more than 46% were abstinent from alcohol and other drugs, and 30% were employed at least part-time. There were only modest improvements shown in the medical and psychiatric status of these women. These preliminary findings suggest that site-level interagency coordination and program-level case management were associated with improvements in the targeted areas as predicted by the model. Future work will require a more closely specified, manual-guided form of the intervention plus the inclusion of control groups and cost measures to fully evaluate the cost benefits from the final form of the intervention.

A model of individual differences that moderate attitude‐behavior consistency was developed and tested in the context of predicting use consistency of the diaphragm. Variables hypothesized to moderate the attitude‐behavior relationship included reactions to major life changes, the attitudes and opinions of others, sexual interest, locus of control, and the perceived susceptibility to pregnancy. Attitudes were conceptualized in terms of a Relative Contraceptive Utility (RCU), which was defined as the difference between the attitude toward the diaphragm and the attitude toward becoming pregnant. Women (N = 110) who attended family planning clinics in the New York Qty area and who used the diaphragm for an 8‐month period were interviewed in the context of a 3‐wave panel design. A threshold function between RCU and behavior was observed, such that when RCU was above an empirically derived cutoff, women tended to use the diaphragm consistently over an 8‐month period. For women with RCUs below the cutoff, attitudes were unrelated to behavior. Inconsistency of diaphragm use for these latter women was best predicted by negative reactions to close friends' experiences with the diaphragm, low levels of perceived susceptibility to pregnancy, alcohol consumption, concern about becoming too old to have children, a preference for nonromantic sex, and the partner's unwillingness to refrain from sex if the women was not prepared.