Extending the Health Belief Model (HBM): Integrating Relational Dynamics into a Sexually Transmitted Infection (STI) Risk Perception Framework for Women Who Have Sex with Women (WSW)

Women who have sex with women (WSW) often misperceive their risks of contracting or transmitting sexually transmitted infections. Reasons for why they are not engaging in safer sexual practices are diverse and complex. Emotional connection and trust have been found to be influential on this decision-making process, yet they are not often considered in studies that use the health belief model (HBM). Therefore, five online focus groups (N = 20) were conducted to better understand this health issue from a relational perspective and two themes emerged from the data: relational negotiations of risk and experiential quests. The themes inform our proposed theoretical extension, relational dynamics, that considers the intersection of both personal beliefs and partner influence on health decision-m3aking. Relational dynamics is defined as the interpersonal influences rooted in trust and emotional connection with sexual partners, to explain why WSW decide to engage, or not engage, in safer sexual practices. We argue that health beliefs among WSW are not shaped solely by individual-level cognitions as traditionally proposed by the HBM, but co-constructed socially and experientially. Our findings contribute to the theoretical development of the HBM and highlight the necessity of educating WSW on how to navigate their relationships as it pertains to their sexual health. Sexual health resources and messaging catered to WSW need to consider the role of a partner’s influence.