Predictors of dual protection use based on information-motivation-behavior skill model among female university students: a cross-sectional study.

Background: The burden of sexually transmitted infections and unintended pregnancy remain a major health problem disproportionately affecting young woman in sub Saharan Africa. While there is a growing interest in promoting dual protection as a means of simultaneously preventing both HIV/STIs and unwanted pregnancy, little is known about patterns and predictors of dual protection use based on theoretical models for designing targeted interventions to promote dual protection for youth. This study aimed to examine predictors of dual protection use based on the information-motivation-behavioral skills model among female university students in Ethiopia.

Methods: A cross-sectional study was conducted with 1,020 female students at Mattu University between April and June 2023. Data were collected using a self-administered questionnaire and analyzed using SPSS version 24. Bivariate and multivariate analyses were conducted using structural equation modeling with AMOS program to examine predictors of dual-protection use.

Results: Of the 1,020 participants, 396 (38.8%) had ever had sexual intercourse, 370 (93.4%) of whom were sexually active in the last 12 months. Of these, only 76 (20.5%) used dual protection at last sex in the past 6 months. Multivariate analysis indicated that dual-protection use was directly and strongly predicted by motivation (β = 0.29, P < 0.001) and behavioral skills (β = 0.27, P < 0.001), whereas it was weakly predicted by information (β = 0.04, P < 0.05), while the information had a strong effect (β = 0.27, p < .001) on behavioral skills to indirectly influence dual protection use.

Conclusion: These findings support the key roles of motivation and behavioral skills in directly predicting dual protection use, while information can also influence behavioral skills to indirectly affect dual protection use, suggesting the importance of incorporating all elements of the IMB model constructs in designing targeted intervention to promote dual protection behaviors for youth.