UCLA Multidimensional Condom Attitudes Scale

Abstract

The UCLA Multidimensional Condom Attitudes Scale (MCAS) is a 25-item psychometric instrument designed to measure complex, multi-faceted attitudes toward condom use. Developed primarily by Marie Helweg-Larsen and colleagues, the scale addresses five statistically independent domains of condom attitudes that influence protective behavior. These domains include the perceived reliability and effectiveness of condoms, the sexual pleasure associated with their use, the social stigma of proposing or using condoms, and two distinct forms of embarrassment: negotiating use and purchasing condoms.

The MCAS was initially validated using ethnically diverse samples of UCLA undergraduates (Helweg-Larsen & Collins, 1994) and has since demonstrated broad applicability across various high-risk and clinical populations globally. Its robust psychometric properties, confirmed through extensive use in research, establish the MCAS as a reliable and valid measure for studying determinants of sexual health behaviors, even among individuals without prior personal experience with condoms. As of August 2008, the scale had been utilized in 31 published articles, reflecting its prominence in sexual health research. A complete list of studies utilizing the MCAS can be found at the companion website for the source book: http://www.routledge.com/textbooks/9780415801751.

Keywords

Condom use, Sexual Health, Attitudes, HIV prevention, Stigma, Embarrassment, Contraception, Reliability, Multidimensional Scale, Psychological assessment.

Authors

Marie Helweg-Larsen, B. E. Collins.

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Purpose

The primary purpose of the UCLA Multidimensional Condom Attitudes Scale (MCAS) is to provide a nuanced measurement of individual attitudes regarding condom use, moving beyond simple positive or negative global scores. This multidimensional approach allows researchers and clinicians to pinpoint specific psychological barriers and facilitators influencing protective sexual behaviors, which is critical for developing effective intervention strategies.

By isolating five independent factors—ranging from practical concerns about reliability and effectiveness to social and emotional hurdles like stigma and embarrassment—the MCAS enables targeted interventions. The scale is designed to be applicable to diverse populations, including those who have never used condoms, by asking them to report how they anticipate they would feel in relevant situations.

Construct

The MCAS measures condom attitudes as a psychological construct composed of five statistically independent factors. These factors represent distinct cognitive and affective domains that collectively determine an individual’s likelihood of using condoms. The independence of these dimensions is crucial, emphasizing that a positive attitude in one area (e.g., reliability) does not necessarily correlate with a positive attitude in another (e.g., pleasure).

The five independent dimensions measured are:

• Reliability and Effectiveness: Beliefs regarding the physical efficacy of condoms in preventing pregnancy and the transmission of sexually transmitted diseases (STDs), including HIV.
• Sexual Pleasure: Attitudes concerning the impact of condom use on sexual enjoyment and sensation.
• Stigma Associated with Condoms: Perceptions of social judgment or negative stereotypes directed toward individuals who propose or use condoms.
• Embarrassment about Negotiation and Use: Feelings of awkwardness or difficulty related to discussing and implementing condom use with a partner.
• Embarrassment about Purchasing Condoms: Discomfort or anxiety experienced when acquiring condoms in public settings.

Validity

The validity of the MCAS has been robustly established through psychometric testing across multiple studies and diverse populations. Initial efforts confirmed Construct Validity by demonstrating that gender and sexual experience were significantly associated with the five factors of the MCAS (Helweg-Larsen & Collins, 1994). This initial validation highlighted that the patterns of correlation between the MCAS factors and criterion variables (such as past or intended condom use) varied substantially between men and women, necessitating gender-specific interpretation.

Further cross-cultural validation has affirmed the scale’s utility beyond the initial college student sample. The MCAS has been successfully validated in diverse groups, including a sample of low-acculturated Hispanic women (Unger & Molina, 1999) and among Mexican undergraduate students (DeSouza et al., 1999). This widespread validation confirms that the MCAS successfully measures the intended underlying constructs of condom attitudes across varied demographic and clinical settings.

Reliability

Internal consistency for the MCAS factors was meticulously established in the original study (Helweg-Larsen & Collins, 1994) across three independent samples, with separate analyses performed for men and women. This foundational work utilized both Factor Analysis and Confirmatory Factor Analysis within Structural Equation Modeling to confirm the scale’s structural integrity.

Subsequent research has consistently reported acceptable Cronbach’s alpha values for each of the five independent factors in studies involving diverse populations (e.g., Maisto et al., 2004; Rosengard et al., 2006). This consistent evidence confirms the MCAS as a stable and reliable measure for assessing multidimensional condom attitudes in sexual health research globally.

Factor Analysis

The structural integrity of the MCAS relies heavily on the results of Factor Analysis, which demonstrated the statistical independence of the five measured dimensions. This independence is paramount, as researchers found that summing the 25 items to generate a single global score resulted in a significant loss of meaningful information, thus confirming that the construct is truly multidimensional.

Both exploratory factor analysis and Confirmatory Factor Analysis (CFA), utilizing Structural Equation Modeling, were employed to establish the factor structure. The results consistently showed that a model with five independent factors provided a significantly superior fit to the data compared to any unidimensional model. Consequently, the five factors must be scored and interpreted separately. Researchers wishing to shorten the scale may select one or more entire factors (all five questions within that factor) or use the factor loading data provided in the original Helweg-Larsen and Collins (1994) publication to guide the selection of a smaller subset of representative questions.

Instrument

Test Type: Psychometric Scale (Self-report questionnaire)

Format: 25 items rated on a 7-point Likert scale (1=Strongly Disagree to 7=Strongly Agree).

Language Available: English, Spanish (DeSouza et al., 1999; Unger & Molina, 1999), Japanese (Kaneko, 2007), and various Zambian languages (Bemba, Nyanja, and Nsenga) (Jones et al., 2005).

Population Group: General and clinical populations, including college students, HIV-positive individuals, drug users, and psychiatric patients.

Age Group: Primarily young adults and adults.

Population Details: Used effectively with ethnically diverse samples, including UCLA undergraduates, HIV-positive individuals in urban clinics, Chinese and Filipina American college women, drug users (cocaine/heroin/opioid-dependent), individuals diagnosed with schizophrenia and mood disorders, and American Indian men.

Test Methodology: Respondents rate their feelings about 25 statements. Negatively worded items must be reverse-scored prior to summing the factors. The scoring procedure requires that the five factors are calculated and interpreted independently.

Keywords

Psychological assessment, Sexual risk behavior, HIV/AIDS, Contraception, Likert scale, College students, Drug addiction, Psychometrics, Reliability, Validity.

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Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: [email protected]

Correspondence Address: Marie Helweg-Larsen, PhD, Department of Psychology, Dickinson College, Carlisle, PA 17013.

Permissions & Fee and Test Year

The original scale was published in 1994 in the journal Health Psychology by the American Psychological Association (APA). The material is copyrighted by the APA, and researchers should seek appropriate permissions for its use. The official citation for referencing this material is: Helweg-Larsen, M., & Collins, B. E. (1994). The UCLA Multidimensional Condom Attitudes Scale: Documenting the complex determinants of condom use in college students. Health Psychology, 13, 224–237. No specific fee information is provided in the source content.

Reference’s

• Avants, S. K., Warburton, L. A., Hawkins, K. A., & Margolin, A. (2000). Continuation of high-risk behavior by HIV-positive drug users: Treatment implications. Journal of Substance Abuse Treatment, 19, 15–22.
• DeSouza, E., Madrigal, C., & Millan, A. (1999). A cross-cultural validation of the Multidimensional Condom Attitudes Scale. Interamerican Journal of Psychology, 33, 191–204.
• Helweg-Larsen, M., & Collins, B. E. (1994). The UCLA Multidimensional Condom Attitudes Scale: Documenting the complex determinants of condom use in college students. Health Psychology, 13, 224–237.
• Jones, D. L., Ross, D., Weiss, S. M., Bhat, G., & Chitalu, N. (2005). Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 82, iv92–iv100.
• Kaneko, N. (2007). Association between condom use and perceived barriers to and self-efficacy of safe sex among young women in Japan. Nursing and Health Sciences, 9, 284–289.
• Lam, A. G., & Barnhart, J. E. (2006). It takes two: The role of partner ethnicity and age characteristics on condom negotiations of heterosexual Chinese and Filipina American college women. AIDS Education and Prevention, 18, 68–80.
• Maisto, S. A., Carey, M. P., Carey, K. B., Gordon, C. M., Schum, J. L., & Lynch, K. G. (2004). The relationship between alcohol and individual differences variables on attitudes and behavioral skills relevant to sexual health among heterosexual young adult men. Archives of Sexual Behavior, 33, 571–584.
• Milam, J., Richardson, J. L., Espinoza, L., & Stoyanoff, S. (2006). Correlates of unprotected sex among adult heterosexual men living with HIV. Journal of Urban Health—Bulletin of the New York Academy of Medicine, 83, 669–681.
• Rosengard, C., Anderson, B. J., & Stein, M. D. (2006). Correlates of condom use and reasons for condom non-use among drug users. The American Journal of Drug and Alcohol Abuse, 32, 637–644.
• Simoni, J. M., Walters, K. L., Balsam, K. F., & Meyers, S. B. (2006). Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian men in New York City. American Journal of Public Health, 96, 2240–2245.
• Unger, J. B., & Molina, G. B. (1999). The UCLA Multidimensional Condom Attitudes Scale: Validity in a sample of low-acculturated Hispanic women. Hispanic Journal of Behavioral Sciences, 21, 199–211.
• Weinhardt, L. S., Carey, M. P., & Carey, K. B. (1997). HIV risk reduction for the seriously mentally ill: Pilot investigation and call for research. Journal of Behavior Therapy and Experimental Psychiatry, 28, 87–95.

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Items of the UCLA Multidimensional Condom Attitudes Scale

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

Please respond to all questions even if you are not sexually active or have never used (or had a partner who used) condoms. In such cases indicate how you think you would feel in such a situation.

Choose a number on the scale below that best represents your feelings about each statement. There are no right or wrong responses to any of these statements. Write the number that best represents your opinion in the blank beside each question.

1. It is really hard to bring up the issue of using condoms to my partner.

2. Use of a condom is an interruption of foreplay.

3. Women think men who use condoms are jerks.

4. Condoms are an effective method of preventing the spread of AIDS and other sexually transmitted diseases.

5. I always feel really uncomfortable when I buy condoms.

6. Condoms are unreliable.

7. When I suggest using a condom I am almost always embarrassed.

8. Condoms ruin the sex act.

9. I think condoms are an excellent means of contraception.

10. I don’t think that buying condoms is awkward.

11. It is very embarrassing to buy condoms.

12. It is easy to suggest to my partner that we use a condom.

13. If a couple is about to have sex and the man suggests using a condom, it is less likely that they will have sex.

14. Condoms do not offer reliable protection.

15. Condoms are a lot of fun.

16. I never know what to say when my partner and I need to talk about condoms or other protection.

17. It would be embarrassing to be seen buying condoms in a store.

18. People who suggest condom use are a little bit geeky.

19. The use of condoms can make sex more stimulating.

20. Condoms are an effective method of birth control.

21. I’m comfortable talking about condoms with my partner.

22. Men who suggest using a condom are really boring.

23. When I need condoms, I often dread having to get them.

24. A woman who suggests using a condom does not trust her partner.

25. Condoms are uncomfortable for both parties.