Developing and testing a theory of intentions to exit street-level prostitution: a mixed methods study

Exiting prostitution is a process whereby women gradually leave prostitution after a number of environmental, relational, and cognitive changes have taken place. Most women attempting to leave street prostitution reenter five or more times before successfully exiting, if they are able to at all. Prostitution-exiting programs are designed to alleviate barriers to exiting, but several studies indicate only about 20-25% of participants enrolled in such programs are successful. There is little quantitative knowledge on the prostitution exiting process and current literature lacks a testable theory of exiting. This mixed-methods study defined and operationalized key cognitive processes by applying the Integrative Model of Behavioral Prediction (IMBP) to measure intentions to exit street-level prostitution. Intentions are thought to be a determinant of behavior and hypothesized as a function of attitudes, norms, and efficacy beliefs. The primary research objective was to measure and test a theory-driven hypothesis examining intentions to exit prostitution. To accomplish these aims, interviews were conducted with 16 men and women involved in prostitution to better capture the latent nuances of exiting (e.g., attitudinal changes, normative influence). These data informed the design of a quantitative instrument that was pilot-tested with a group of former prostitutes and reviewed by experts in the field. The quantitative phase focused on validating the instrument and testing the theory in a full latent variable structural equation model with a sample of 160 former and active prostitutes. Ultimately, the theory and instrument developed in this study will lay the foundation to test interventions for street prostituted women. Prior research has only been able to describe, but not explain or predict, the prostitution exiting process. This study fills a gap in literature by providing a quantitative examination of women's intentions to leave prostitution. The results contribute to our understanding of the cognitive changes that occur when a person leaves prostitution, and the validated instrument may be used as an intervention assessment or an exit prediction tool. Success in predicting an individual's passage through the exiting process could have important and far-reaching implications on recidivism policies or interventions for this vulnerable group of women.