Discussion
SWEENEY
Despite numerous studies documenting the salutary effects of self-affirmation on health outcomes, our large-sample study found no evidence that self-affirmation led FSWs in Senegal to accept threatening information about their risk of contracting HIV (H1), to take steps toward practicing safer sex (e.g., by accepting an offer of free condoms) (H2), or to sign up and show up for an HIV test (H3)—even when the affirmation was accompanied by self-efficacy information about the benefits of HIV testing (H4). The null effect of self-efficacy information could reflect the possibility that FSWs already know this information.We consider several potential explanations for the null effects of self-affirmation. Like any null effects, the present results cannot prove that self-affirmation had no effect, because it is possible that any effect size was too small for our study to detect. However, our study’s large sample size allows us to conclude that if self-affirmation does affect our outcome measures in this population, the size of such an effect is likely to be small. Ours was one of the largest studies of self-affirmation and health behaviors; for example, fewer than 8% of the studies in Sweeney and Moyer’s meta-analysis [Another explanation is that the self-affirmation manipulation failed to make participants feel affirmed. Although this specific manipulation—asking participants to reflect on a source of personal pride—is common in the self-affirmation literature [Perhaps cultural factors explain our results. As noted, most studies on self-affirmation and health have been conducted in the US and UK, which are two of the most individualistic countries in the world, whereas the present study was conducted in Senegal, which has a more collectivistic culture [Another explanation we considered concerns the high degree of stigma associated with sex work and HIV in Senegal [It is possible that the self-affirmation intervention did not significantly increase the uptake of condoms because participants already had enough condoms. Indeed, when we asked participants who left some condoms in the bowl why they did so (Finally, our intervention may not have improved HIV-prevention behaviors because factors other than psychological barriers have a large influence on these behaviors. For example, FSWs do not simply decide themselves whether to use condoms; they must bargain with clients, who are generally willing to pay more for unprotected sex [In short, although more research would be needed to understand exactly why self-affirmation did not significantly improve health behaviors among FSWs in Senegal, or whether the same results would emerge in other populations, our findings raise the possibility that self-affirmation may not be the best tool to improve health in highly stigmatized populations.Our results highlight limitations of prior research on self-affirmation. On one hand, positive effects of self-affirmation have been documented in diverse domains and contexts [These findings thus highlight the need for more research on the effects of self-affirmation in diverse populations. Like most theories in social psychology, self-affirmation theory was developed mainly using research on participants from Western, educated, industrialized, rich, and democratic (i.e., “WEIRD”) societies that represent only a minority of the world’s population [