Tailoring safer sex messages to lower-educated young gay men: the impact on cognitions and intention

Abstract

In order to test whether simplifying information about HIV risk or tailoring arguments that are meant to promote the use of condoms would enhance the effects of safer sex messages on men of lower education, we conducted an experimental study. We recruited 51 lower-educated young Dutch gay men (i.e., men who stopped their training after they had completed general education or lower vocational training). We randomly assigned these men to read a safer sex brochure that is widely distributed among gay men in The Netherlands (the ‘standard message’) or one of three alternative versions. In the alternative messages we (1) reduced the complexity of the information about HIV risk, (2) obtained a closer match between the arguments that are meant to promote the use of condoms and the salient beliefs about safer sex in men of lower SES (among others we gave information about how to cope with situations that these men find difficult to handle), or (3) manipulated both aspects of message content. After exposure to one of the messages, participants completed a self-administered questionnaire that tapped social cognitions about safer sex. We also included 106 higher-educated men in our experiment (i.e., men who had completed high school, college, applied arts and sciences education, or academic and theoretical education). This allowed us to test whether tailoring messages to lower-educated men would have negative effects on higher-educated men. The results showed that simplifying information about HIV risk did not affect knowledge levels. Exposing lower-educated participants to the tailored arguments promoting the use of condoms, however, enhanced these men's intention to engage in protected anal sex. This effect was associated with an increase in men's perception of behavioural control. No negative effects of the manipulations of messages were found in higher-educated participants.This study emphasizes the importance of addressing control issues that are relevant to men of lower SES in order to increase the effectiveness of messages in encouraging preventive action.

Acknowledgments

We would like to thank Roel Coutinho, Director of the Amsterdam Municipal Health Service, for his support, and Ree Meertens, Department of Health Promotion at the University of Maastricht, for her helpful comments. We feel grateful to all participants for their trust, time and effort. This study was financially supported by the Netherlands Foundation for Preventive Medicine (‘Praeventiefonds’) upon nomination by the Dutch Program Committee on AIDS Research (grant number 28-2837).

Notes

Following elementary school, students in The Netherlands receive either vocational or professional/academic training. In the posttest questionnaire we asked participants to indicate their training. We used that information to compute an indicator for SES that distinguished between men who had achieved lower or higher educational status. Compared to US educational levels, these two levels roughly reflect (1) completed general education or lower vocational training only, and (2) high school, college, applied arts and sciences, or academic and theoretical education, respectively.

Participants were not informed about the research design and the experimentor was unaware of the brochure that participants received; he handed out closed envelopes that contained one of the four brochures and the posttest questionnaire. The questionnaire had a hidden code that enabled us to identify the brochure that participants were exposed to.