Correct Condom Use Self-Efficacy Scale

Abstract

The Correct Condom Use Self-Efficacy Scale (CCUSS) is a concise, 7-item psychometric instrument designed to quantify an individual’s perceived ease or difficulty in performing tasks associated with the correct application and use of male condoms. This scale was developed based on extensive prior research identifying common condom use errors and problems that occur before, during, and after sexual intercourse. The CCUSS provides a domain-specific measure of self-efficacy, focusing specifically on behavioral competence rather than general attitudes or intentions regarding safer sex practices. Its utility lies in public health research aimed at improving techniques for preventing the transmission of HIV and reducing the risk of other sexually transmitted infections.

Keywords

Condom use, Self-Efficacy, CCUSS, HIV prevention, STI prevention, Sexual health, Psychometric scale, Correct condom use.

Authors

Richard A. Crosby, Cynthia A. Graham, Robin R. Milhausen, Stephanie A. Sanders, William L. Yarber.

Purpose

The primary purpose of the CCUSS is to provide researchers and public health professionals with a precise instrument to measure an individual’s perceived capability to perform specific behaviors required for the correct use of male condoms. Consistent and correct condom use remains a cornerstone of effective STI and HIV prevention, yet many previous measures of associated psychosocial constructs were too broad, often assessing generalized knowledge or intentions rather than an individual’s practical confidence.

The scale addresses a critical need for a tool that assesses domain-specific self-efficacy. By focusing on practical, specific behaviors—such as finding the correct fit, ensuring lubrication, and proper withdrawal—the CCUSS offers a granular assessment of behavioral confidence, which is theoretically linked to actual consistent and correct condom use, thereby minimizing common errors and maximizing protection.

Construct

The CCUSS measures Condom Use Self-Efficacy, a concept rooted in Albert Bandura’s Social Cognitive Theory. Bandura defined self-efficacy as an individual’s belief in their capacity to execute behaviors necessary to produce specific performance attainments. In the context of sexual health, condom use self-efficacy refers to an individual’s confidence in their ability to maintain control over their motivation, behavior, and social environment to successfully use condoms (Forsyth & Carey, 1998).

The scale’s items were specifically chosen to reflect the known errors and problems that undermine condom effectiveness. This approach ensures that the CCUSS measures perceived ability related to the actual mechanical and interpersonal difficulties of correct use, distinguishing it from measures of general health motivation or behavioral intentions.

Validity

The validity of the CCUSS is supported by its demonstrated association with observed behavioral outcomes, confirming its utility as a predictor of safer sexual practices. Research by Crosby, Salazar, et al. (2008) found that greater self-efficacy for correct use of condoms, as measured by the CCUSS, was significantly associated with respondents reporting fewer condom use errors and problems.

This finding supports the scale’s predictive and construct validity, suggesting that it accurately measures the perceived capability to perform correct behaviors, which in turn predicts a reduction in risky or ineffective condom practices. Furthermore, the scale’s development was based on extensive empirical research defining common condom use errors, strengthening its inherent content validity regarding the critical stages of condom usage.

Reliability

The internal consistency of the Correct Condom Use Self-Efficacy Scale has been assessed using Cronbach’s alpha. In the initial validation study involving a sample of 278 adult male clients attending a sexually transmitted infections (STI) clinic, the scale produced an alpha coefficient of .70 (Crosby, Salazar, et al., 2008).

A Cronbach’s alpha of .70 is generally considered an acceptable level of reliability for scales used in psychological and behavioral health research, particularly for instruments with a limited number of items. This result indicates that the 7 items consistently measure the underlying construct of correct condom use self-efficacy.

Factor Analysis

The source content does not explicitly detail the results of a formal factor analysis (such as Exploratory or Confirmatory Factor Analysis) to verify the underlying dimensional structure of the CCUSS. However, the scale is designed as a cohesive, 7-item instrument intended to measure a singular, domain-specific construct: confidence in performing the necessary steps for correct condom application and use.

The CCUSS is typically treated as a unidimensional measure, with scores summed to reflect overall self-efficacy. Future research applying the CCUSS across diverse populations could benefit from formal factor analysis to confirm its unidimensionality and ensure that the items do not separate into distinct factors corresponding to different stages of sexual activity (e.g., pre-coital, coital, post-coital).

Instrument

Test Type: Domain-Specific Self-Efficacy Scale

Format: 7-item, self-report questionnaire using a Likert-type response scale.

Language Available: English (Original development language).

Population Group: Individuals who use or intend to use male condoms (primarily validated on male clients).

Age Group: Adult males.

Population Details: Initial validation was conducted on a sample of 278 adult male clients attending a sexually transmitted infections (STI) clinic. The mean summed score for this sample was 27.61 (SD = 4.37), with scores ranging from 8 to 35.

Test Methodology: Respondents are asked to rate the perceived ease or difficulty of performing specific correct condom use tasks. Responses are provided using a 5-point scale ranging from 1 (Very Difficult) to 5 (Very Easy). Items are summed, with higher scores indicating greater self-efficacy.

Keywords

CCUSS, Sexual behavior, Self-efficacy assessment, Scale development, Reliability, STI clinic population, Behavioral competence, Condom errors.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Not explicitly provided in source material.

Correspondence Address: William L. Yarber, Department of Applied Health Science, Indiana University, Bloomington, Indiana 47405; e-mail: [email protected]

Permissions & Fee and Test Year

The scale was developed and validated based on research published around 2008 (Crosby, Salazar, et al., 2008). Specific fee information is not provided in the source material. Researchers seeking to utilize the CCUSS should contact the corresponding author, William L. Yarber, for explicit permission and guidance on proper academic citation and usage.

References

• Bandura, A. (1994). Social cognitive theory and exercise of control over HIV infection. In R. J. DiClemente & J. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 25–59). New York: Plenum.
• Centers for Disease Control and Prevention. (2009). Condoms and STDs: Fact sheet for public health personnel. Retrieved May 18, 2009, from http://www.cdc.gov/condomeffectiveness/latex.htm
• Crosby, R., Milhausen, R., Sanders, S., Graham, C., & Yarber, W. (2008). Two heads are better than one: The association between condom decision-making and condom use errors and problems. Sexually Transmitted Infections, 84, 196–201.
• Crosby, R. A., Salazar, L. F., Yarber, W. L., Sanders, S. A., Graham, C. A., Head, S., et al. (2008). A theory-based approach to understanding condom errors and problems reported by men attending an STI clinic. AIDS and Behavior, 12, 412–418.
• Crosby, R. A., Sanders, S. A., Yarber, W. L., Graham, C. A., & Dodge, B. (2002). Condom use errors and problems among college men. Sexually Transmitted Disease, 29, 552–557.
• Forsyth, A. D., & Carey, M. P. (1998). Measuring self-efficacy in the context of HIV risk reduction: Research challenges and recommendations. Health Psychology, 17, 559–568.
• Goldman, J. A., & Harlow, L. L. (1993). Self-perception variables that mediate AIDS-preventive behavior in college students. Health Psychology, 12, 489–498.
• Graham, C. A., Crosby, R. A., Yarber, W. L., Sanders, S. A., McBride, K., Milhausen, R. R., et al. (2006). Erection loss in association with condom use among young men attending a public STI clinic: Potential correlates and implications for risk behavior. Sexual Health, 3, 255– 260.
• Lux, K. M., & Petosa, R. (1994). Using the health belief model to predict safer sex intentions of incarcerated youth. Health Education Quarterly, 21, 487–497.
• Milhausen, R. R., Wood, J., Crosby, R. A., Graham, C. A., Sanders, S. A., & Yarber, W. L. (2009). A novel home-based intervention to promote condom use among young heterosexual males: A pilot study. Manuscript in preparation.
• Sanders, S. A., Graham, C. A., Yarber, W. L., Crosby, R. A., Dodge, B., & Milhausen, R. R. (2003). Condom use errors and problems among women who put condoms on their male partners. Journal of the American Medical Women’s Association, 58, 95–98.
• Sanders, S. A., Milhausen, R. R., Crosby, R. A., Graham, C. A., & Yarber, W. L. (2009). Do phosphodiesterase type 5 inhibitors protect against condom-associated erection loss and condom slippage? Journal of Sexual Medicine, 6, 1451–1456.
• Schaalma, H., Kok, G., & Peters, L. (1993). Determinants of consistent condom use by adolescents: The impact of experience of sexual intercourse. Health Education Research, 8, 255–269.
• St. Lawrence, J. S., Brasfield, T. L., Jefferson, K. W., Alleyne, E., & Shirley, A. (1994). Social support as a factor in African American adolescents’ sexual risk behavior. Journal of Adolescent Health, 9, 292–310.
• Wulfert, E., & Wan, C. K. (1993). Condom use: A self-efficacy model. Health Psychology, 12, 346–353.
• Yarber, W. L., Graham, C. A., Sanders, S. A., & Crosby, R. A. (2004). Correlates of condom breakage and slippage among university students. International Journal of STD and AIDS, 15, 467–472.
• Yarber, W. L., Kennedy, J., Sanders, S. A., Crosby, R. A., Graham, C. A., Heckman, T. G., et al. (2005). Prevalence of condom use errors and problems among Indiana rural men: An exploratory telephone survey. The Health Education Monograph, 22(3), 36–38.

Items of the Correct Condom Use Self-Efficacy Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Directions: Please circle the number that represents how easy or difficult it would be to do what each question asks. For example, if you thought a behavior in the statement would be very easy, you would circle number “5.”

1. How easy or difficult would it be for you to find condoms that fit you properly?
2. How easy or difficult would it be for you to apply condoms correctly? Very Difficult
3. How easy or difficult would it be for you to keep a condom from drying out during sex? Very Difficult
4. How easy or difficult would it be for you to keep a condom from breaking during sex? Very Difficult
5. How easy or difficult would it be for you to keep an erection while using a condom? Very Difficult
6. How easy or difficult would it be for you to keep a condom on when withdrawing after sex? Very Difficult
7. How difficult would it be for you to wear a condom from start to finish of sex with your partner?