Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Attitudes and Beliefs Related to Risk of Sexually Transmitted Infection in Swingers Who Do Not Use Condoms Deborah Brown Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion Commons, and the Social Psychology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Deborah J. Brown has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Garth den Heyer, Committee Chairperson, Human Services Faculty Dr. Rebecca Stout, Committee Member, Human Services Faculty Dr. Andrew Garland-Forshee, University Reviewer, Human Services Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Attitudes and Beliefs Related to Risk of Sexually Transmitted Infection in Swingers Who Do Not Use Condoms by Deborah J. Brown MPhil, Walden University, 2019 MS, Walden University, 2011 BA, Rowan University, 1992 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Human and Social Services Walden University June 2020 Abstract Sexually transmitted infection (STI) affects the public as a hidden epidemic of contagious disease with significant economic and health impacts. There are 110 million living with STI in the United States, with 20 million new infections annually. Condom use can reduce STI, but some people have sex without condoms, with risk for contracting or transmitting STI increasing when a person is in the same sexual network. Swingers are a growing sexual network and are a group at high risk of developing and spreading STI. The purpose of this generic qualitative study was to develop an understanding of the attitudes and beliefs of swingers related to the risk of contracting STI among swingers who do not use condoms. The health belief model formed the theoretical framework of the study. A description of the individual swinger’s experiences, attitudes, and beliefs was collected during face-to-face interviews with 18 participants. Results showed that participants were knowledgeable about the nature and consequences of STI, and they continued to engage in high risk sexual behaviors. The findings identified cognitive dissonance—a distinct separation between logical/cognitive and emotional/affective factors in decision making related to sexual health, specifically condom use. This was due to the pleasure-seeking norms of this group and the lack of expectations and requirements related to condom use. It was determined that only when condoms were required in order to have sex, participants would utilize them. Implications for social change include the development of prevention strategies that address the cognitive dissonance present in high risk sexual behaviors. Attitudes and Beliefs Related to Risk of Sexually Transmitted Infection in Swingers Who Do Not Use Condoms by Deborah J. Brown MPhil, Walden University, 2019 MS, Walden University, 2011 BA, Rowan University, 1992 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Human and Social Services Walden University June 2020 Dedication This work is dedicated to those who rise above and persist, even when life seems impossible or when goals appear beyond reach. This includes those I have had the honor of serving in my clinical work; supporting them has inspired me and taught me valuable lessons on how to live, grow, and evolve. Also, to my colleagues who promote health and wellness by serving those in need with unfaltering kindness and humor. You are the true superheroes in our society. I dedicate this to Scott Brown without whose support and encouragement I would never have begun this effort. Thank you for reminding me of what I could become, telling me of the lotus flower, springing up through swampy waters, reaching for the sun. Also, to my siblings, Patricia, Randy, Martin, and Betsy. I eagerly await our continued growth together in this life: this is a big one for me. To my aunts, Bette and Jane. As a child, they demonstrated that more was possible beyond where I was, that there was an over the rainbow place I could be someday. To Meggin, the first doctor in the family, for leading by example. To Katie, who has saved my life both literally and figuratively: your years of unwavering belief in me have been invaluable. And to my son, George R. Brown. You remain my best endeavor. May you learn from being by my side through this process that even when things become difficult, they are still worth doing. You have sacrificed for this too, as my time and energy were often taken from you to do this work. This is for you, truly. Acknowledgments I would like to express thanks for the support of my Walden University committee, Dr. Garth den Heyer and Dr. Rebecca Stout. It is through your support, generous and kind guidance, and encouragement that this work came to fruition. Table of Contents List of Tables ...................................................................................................................... v Chapter 1: Introduction to the Study ................................................................................... 1 Background ..................................................................................................................... 1 Problem Statement .......................................................................................................... 3 Purpose of the Study ....................................................................................................... 4 Research Question ........................................................................................................... 4 Theoretical Framework ................................................................................................... 5 Nature of the Study ......................................................................................................... 6 Definition of Terms ......................................................................................................... 7 Assumptions and Limitations ........................................................................................ 11 Scope of the Study......................................................................................................... 12 Significance of the Study .............................................................................................. 12 Summary ....................................................................................................................... 13 Chapter 2: Literature Review ............................................................................................ 15 Introduction ................................................................................................................... 15 Literature Search Strategy ............................................................................................. 15 Literature Review Related to Key Concepts ................................................................. 16 Sexually Transmitted Infection ................................................................................. 16 Consensual Nonmonogamy ....................................................................................... 18 Swingers .................................................................................................................... 22 Health Decision-Making............................................................................................ 44 i Health Belief Model .................................................................................................. 47 Prevention .................................................................................................................. 48 Health Promotion ....................................................................................................... 49 Research Related to Swingers ................................................................................... 51 Challenges to Swinger Research ............................................................................... 52 Conclusion ..................................................................................................................... 54 Chapter 3: Research Method ............................................................................................. 56 Introduction ................................................................................................................... 56 Research Design and Rationale ..................................................................................... 56 Role of Researcher ........................................................................................................ 57 Methodology ................................................................................................................. 58 Participants ...............................................................................................................