The effects of self-efficacy in bifurcating the relationship of perceived benefit and cost with condom use among adolescents: A cusp catastrophe modeling analysis.

This study tested the complex relationship among the perceived benefit from and cost of condom use, self-efficacy and condom use among adolescents as a nonlinear dynamic process. Participants were 12th graders in public Bahamian high schools who reported having had sex and frequency of condom use. Results revealed that the perceived benefit and perceived cost as asymmetry variables were significantly associated with condom use (p < 0.001) after controlling for covariates. The association was bifurcated by the variable self-efficacy (p < 0.001). Furthermore, the cusp model was better than linear and logistic regression models in predicting the dynamic changes in condom use behavior, judged by the AIC and BIC, and R2 criteria. These results suggest that adolescent condom use may follow a nonlinear rather than linear dynamic process. Emphasizing bifurcation variables such as self-efficacy that promote sudden change could be essential to strengthen current evidence-based intervention programs in encouraging condom use.