Various efforts aimed at preventing the spread of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) continue to be implemented worldwide, thereby resulting in fewer HIV cases. People diagnosed with STDs may be at an increased risk of contracting HIV (CDC, 2014). Nevertheless, young people continue to be at high of contracting STDs and HIV (CDC, 2017 b). Additionally, youth aged 15 to 24 years account for 10 million new STD cases in the US each year (CDC, 2017 a), and this number continues to increase steadily. Furthermore, in 2018, those between 13 and 24 years accounted for 21% of all the new HIV diagnoses, and approximately 80% of cases of new diagnoses of the 13–24 bracket involved young people aged 20‒24 years (CDC, 2018). Similar results have been observed in South Korea. According to a 2020 report presented by the Korea Disease Control and Prevention Agency (2021), 1,016 people in South Korea were diagnosed with HIV and acquired immune deficiency syndrome (HIV/AIDS). According to the report, people in their 20s accounted for 33.8% (n = 343) of the total cases, followed by those in their 30s who accounted for 29.8% (n = 303) of the total cases. These results showed that young people play a significant role in preventing the spread of HIV/AIDS worldwide.
Generally, during early adulthood, sex-related value systems are not established fully, and as a result, young adults can be vulnerable to subjective judgments or choices regarding sexual behavior (Choi, 2016). Therefore, young adults are at high risk of engaging in several risky sexual activities, such as sexual intercourse with multiple partners, unprotected sex, or sexual intercourse under the influence of drugs or alcohol (Ritchwood, Ford, DeCoster, Sutton, & Lochman, 2015). Unsafe, risky, or unprotected sexual intercourse that increases the risk of STD/HIV infection. Risky behavior involves engaging in sexual intercourse or other sexual activities without protection (AVERT, 2019). Safe sex can significantly reduce the incidence of STDs, HIV, and unintentional pregnancy (Zhao et al., 2016). Condom use has been identified as a crucial approach aimed at preventing such outcomes (CDC, 2016). Among the youth, condom use is considered a critical, cost-effective, and easily accessible approach for preventing HIV/AIDS infection (Widman, Noar, Choukas-Bradley, & Francis, 2014).
In terms of national health promotion and infection control, increasing the level of condom use among the youth is a priority (CDC, 2015). However, the level of condom use among young adults remains inconsistent or low (Kanda & Mash, 2018; Widman et al., 2014; Zhao et al., 2016). In the US, between 2011 and 2015, 47.3% of men and 59.9% of women aged 15‒44 years did not use condoms while engaging in sexual intercourse in the past year (Copen, 2017). A study by Lee (2017) showed similar results, whereby only 25%‒38.2% of young people used proper contraception, including condom use, in the past year. Among teenagers who do not use condoms, 17.1% reported to have contracted STDs (Park, Seo, Jeong, & Lee, 2017).
However, to the best of our knowledge, there is currently no instrument to measure the intent to use condoms among Korean college students. Therefore, in this study, an instrument for examining the intent for condom use among Korean students was adapted. This instrument could play a significant role in explaining risky sexual behavior among the youth. Further, this study aims to adapt the English version of the sexual risk behavior beliefs and self-efficacy (SRBBS) instrument cross-culturally by translating it into Korean and investigating the psychometric properties of the translated version. The SRBBS instrument was selected because it highlights specific aspects of risky sexual behaviors associated with the concepts presented in this study.
Theory of Planned Behavior
The concepts associated with the aforementioned instrument were derived from the theory of reasoned action, social learning theory, and the health belief model (Fisher, Davis, & Yarber, 2013, p. 588). The theory of planned behavior (TPB) plays a significant role in explaining the reasons for unsafe and risky sexual behaviors among Korean young adults. Most previous studies on this subject have demonstrated that young adults do not use condoms because they are unaware of the potential risks (e.g., misconceptions and/or misunderstandings) and as a result of subjective norms (e.g., cultural and/or social norms). Findings from previous studies also show that risky sexual behavior among the youth is significantly associated with their attitudes and beliefs regarding condom use (Ramiro, Reis, Matos, & Diniz, 2014).
According to the TPB, four concepts could affect sexual behaviors among young adults: attitude, subjective norms, intention, and perceived behavioral control (PBC). Because we cannot examine sexual behavior among the youth directly, the intention to use condoms will be used as a proxy for safe sexual behavior using three concepts based on the TPB. The TPB assumes that certain behaviors are predicted by the individual’s intention to engage in a specific behavior (Ajzen, 1991). Furthermore, the predictors of the intention to engage in specific behaviors include attitudes, subjective norms, and PBC. First, attitudes toward specific behaviors indicate the way in which actions seem desirable to each individual; this attribute is determined based on an individual’s mindset or beliefs, especially the perceived outcomes of the behavior and the value placed on such outcomes. Second, subjective norms indicate the way in which others perceive behaviors and the way in which an individual’s behavior could be influenced by significant referents’ perceptions or beliefs. Third, intention indicates an individual's decision to engage in specific behaviors, such as risky or unprotected sexual intercourse. In this study, the intention to use condoms is considered a surrogate for sexual behavior. Finally, PBC can indicate an individual’s ability to engage in a specific behavior, and this concept refers to perceived facilitators of or barriers to enacting a specific behavior.