The Information-Motivation-Behavioral Skills Model Revisited: A Network-Perspective Structural Equation Model Within a Public Sexually Transmitted Infection Clinic Sample of Hazardous Alcohol Users

Development and implementation of a worksite-based intervention to improve mothers' knowledge, attitudes, and skills in sharing information with their adolescent daughters on preventing sexual violence: lessons learned in a developing setting, Sri Lanka

BACKGROUND

Sexual violence among adolescents has become a major public health concern in Sri Lanka. Lack of sexual awareness is a major reason for adverse sexual health outcomes among adolescents in Sri Lanka. This study was intended to explore the effectiveness of a worksite-based parent-targeted intervention to improve mothers' knowledge, and attitudes on preventing sexual violence among their adolescent female offspring and to improve mother-daughter communication of sexual violence prevention with the family.

METHODS

"My mother is my best friend" is an intervention designed based on previous research and behavioral theories, to help parents to improve their sexual communication skills with their adolescent daughters. A quasi-experimental study was conducted from August 2020 to March 2023 in randomly selected two Medical Officer of Health (MOH)areas in Kalutara district, Sri Lanka. Pre and post-assessments were conducted among a sample of 135 mothers of adolescent girls aged 14-19 years in both intervention and control areas.

RESULTS

Out of the 135 mothers who participated in the baseline survey, 127 mothers (94.1%) from the intervention area (IA) physically participated in at least one session of the intervention. The worksite-based intervention was effective in improving mothers' knowledge about adolescent sexual abuse prevention (Difference in percentage difference of pre and post intervention scores in IA and CA = 4.3%, p = 0.004), mother's attitudes in communicating sexual abuse prevention with adolescent girls (Difference in percentage difference of pre and post intervention scores in IA and CA = 5.9%, p = 0.005), and the content of mother-daughter sexual communication (Difference in percentage difference of pre and post intervention scores in IA and CA = 27.1%, p < 0.001).

CONCLUSIONS AND RECOMMENDATIONS

Worksite-based parenting program was effective in improving mothers' knowledge about sexual abuse prevention among adolescent daughters and in improving the content of mother-daughter communication about sexual abuse prevention. Developing appropriate sexual health programs for mothers of different ethnicities, and cultures using different settings is important. Conduction of need assessment programs to identify the different needs of mothers is recommended.

The development of a novel sexual health promotion intervention for young people with mental ill-health: the PROSPEct project

BACKGROUND

Young people with mental ill-health experience higher rates of high-risk sexual behaviour, have poorer sexual health outcomes, and lower satisfaction with their sexual wellbeing compared to their peers. Ensuring good sexual health in this cohort is a public health concern, but best practice intervention in the area remains under-researched. This study aimed to co-design a novel intervention to address the sexual health needs of young people with mental ill-health to test its effectiveness in a future trial undertaken in youth mental health services in Melbourne, Australia.

METHODS

We followed the 2022 Medical Research Council (MRC) guidelines for developing and evaluating complex interventions. This involved synthesising evidence from the 'top down' (published evidence) and 'bottom up' (stakeholder views). We combined systematic review findings with data elicited from qualitative interviews and focus groups with young people, carers, and clinicians and identified critical cultural issues to inform the development of our intervention.

RESULTS

Existing evidence in the field of sexual health in youth mental health was limited but suggested the need to address sexual wellbeing as a concept broader than an absence of negative health outcomes. The Information-Motivation-Belief (IMB) model was chosen as the theoretical Framework on which to base the intervention. Interviews/focus groups were conducted with 29 stakeholders (18 clinicians, three carers, and eight young people). Synthesis of the evidence gathered resulted in the co-design of a novel intervention consisting of an initial consultation and four 60-90-minute sessions delivered individually by a young 'sex-positive' clinician with additional training in sexual health. Barriers and supports to intervention success were also identified.

CONCLUSIONS

Using the MRC Framework has guided the co-design of a potentially promising intervention that addresses the sexual health needs of young people with mental ill-health. The next step is to test the intervention in a one-arm feasibility trial.

Assessing the Preliminary Efficacy of a Nonrandomized, Clinic-Based HIV Risk Reduction Pilot Intervention for PrEP-Initiated, Alcohol- and Other Drug-Using Women of Color in Miami, FL

In this paper, we assessed the preliminary efficacy and acceptability of a quasi-experimental, clinic-based sexual risk reduction pilot intervention for pre-exposure prophylaxis (PrEP)-initiated, alcohol- and other drug-using women of color and explored their self-reported barriers to, and facilitators of, PrEP use. Using a mixed methods design, analyses incorporated pre- and post-intervention study assessment data from 38 women and semi-structured process evaluations using a subsample of 25. The intervention administered over an 8-week period consisted of 4 one-on-one in person educational sessions, a process evaluation, and study assessments conducted at baseline and 3 and 6 months. Post intervention, statistically significant changes in sexual risk scores were not observed; however, we found significant decreases in alcohol use (Z =  - 3.02, p = .003, η2 = .41). Process evaluation data revealed interpersonal relationships as a key motivator for PrEP initiation as well as a prominent barrier to PrEP use; these relationships rarely facilitated adherence. Overall, women found the intervention to be acceptable and reported a wide range of benefits of participation-most notably its therapeutic benefits. Findings from this study provide preliminary evidence of the potential for the Talking PrEP with Women of Color intervention to improve risky behaviors, knowledge, and attitudes related to sexual risk taking. Furthermore, findings suggest that interventions to increase PrEP uptake and adherence in at-risk women may benefit from supporting them in accurately estimating their risk for HIV and increasing their sense of social support.

Combination of Digital and Conventional Intervention for Sexually Transmitted Infections Prevention among Female Sex Workers

Background

Female sex workers (FSWs) are at a high risk of contracting sexually transmitted infection (STI). Mobile health (m-health) is one intervention that is easily accessible to everyone online and offline, allowing two-way communication through the program. This study aimed to determine the effectiveness of m-health on STI prevention behavior among FSW.

Methods

The study was conducted using quasi-experimental design. It included the treatment group and the control group, each of which included fifty-four (54) FSWs selected by purposive sampling. The m-health intervention was conducted in the form of a short comedy movie on YouTube, combined with offline assertive communication training to improve skills in negotiating the use of condoms to the intervention group. Meanwhile, the control group received regular counseling from the local community health center. The Mann-Whitney test was used to compare the knowledge, attitudes, motivation, and behavior among the two study groups.

Results

Intervention for six months in the treatment group increased FSWs knowledge score by 4.0 (p=0.00), attitude by 3.9 (p=0.00), and motivation by 12 (p=0.00). The median knowledge, attitude, and motivation scores were 17.38 and 46, respectively. The model is effective onSTI-prevention behavior through motivational mediator variables with a p-value of 0.00. The condom consistency has the highest outer loading value in the STI-prevention behavior construct of 0.71 ≥ 0.4.

Conclusions

A combination of digital and conventional health promotion can improve STI prevention behavior by raising knowledge, attitudes, motivation, and condom consistency behavior.

How can we improve the acceptability of vaccination against Human Papillomavirus (HPV) in France? An original qualitative study with focus groups comprising parents and school staff, interviewed separately

BACKGROUND

It has been proven that vaccination is effective against Human Papillomavirus (HPV) infections, genital warts, and pre-cancerous and cancerous cervical lesions. Nevertheless, the HPV vaccine coverage of 37.4 % in 2021 in France is one of the lowest in Europe. To explore and understand the reason why French population is so late compared to its neighbours, we carried out focus groups with mothers and with National Education school staff. We aimed to identify knowledge and perceptions of HPV in both study populations, as well as factors influencing HPV vaccination.

METHODS

Between January 2020 and March 2021, we performed a qualitative study using an inductive approach with a thematic content analysis (TCA). We conducted semi-structured focus groups with 29 people including 15 mothers of adolescents in middle schools and 14 school staff from the national education system.

RESULTS

Different factors influenced the decision-making process of parents and school staff: knowledge and perceptions of HPV and its vaccine, sources of information about HPV and vaccination. Mothers' discourses differed from those of school staff. They mentioned the importance of gynaecological monitoring and the negative image of pharmaceutical companies, and questioned internet as a reliable source of information. For their part, school staff mentioned cultural and/or religious affiliation, municipalities' role to inform the population, and ethical dilemma or logistical challenges regarding HPV vaccination in schools.

CONCLUSION

The results of these focus groups provided information on which elements may harm or help HPV vaccination. Identified perceptions, beliefs, knowledge, barriers, and facilitators will help us to build an intervention program focus on general practitioners (GP), school staff, parents, and adolescents.

Validation and adaption of an Information-Motivation-Behavioral Skills model of medication adherence in older patients with multimorbidity

OBJECTIVE

To test and adapt the Information-Motivation-Behavioral Skills (IMB) model in explaining medication adherence for older patients with multimorbidity.

METHODS

Older patients with at least three chronic conditions (N = 254) were recruited from community health centers in Changsha, China. All participants completed a self-administrated questionnaire assessing adherence information, personal motivation, social motivation, behavioral skills, medication adherence, depressive symptoms, medication treatment satisfaction, treatment burden, and disease burden. Structural equation modeling was used to examine the hypothesized models and relationships between variables.

RESULTS

The final extended IMB model could explain 52.0% of the variance in adherence. Personal motivation (β = 0.29, p < 0.001), behavioral skills (β = 0.36, p < 0.001), and medication treatment satisfaction (β = 0.23, p = 0.001) had a positive direct effect on adherence. Information, social motivation, personal motivation, medication treatment satisfaction, and treatment burden could also affect adherence indirectly through multiple pathways.

CONCLUSION

This study demonstrated that an extended IMB model could be used to conceptualize determinants of medication adherence among older patients with multimorbidity.

PRACTICAL IMPLICATIONS

Adherence improvement programs might be more effective if targeting psychosocial factors, including adherence information, motivation, behavioral skills, treatment burden, and medication treatment satisfaction.

A Psychometric and Relative Importance Evaluation of Health Literacy and Health Consciousness on COVID-19 Preventive Behaviors Among Hispanic Adults

Given the COVID-19 pandemic's disproportionate impact on Hispanic individuals in the United States, research examining modifiable psychosocial correlates of COVID-19 preventive behaviors in this population is warranted. Prior research highlights health literacy and health consciousness as integral for the establishment of health-promoting behaviors. Notwithstanding, very little research has validated theory-based measures for health literacy and health consciousness and no research has investigated their relative importance in explaining behaviors that prevent COVID-19 illness among Hispanic individuals. This information is necessary for informing behavioral interventions seeking to promote the well-being of Hispanic people during the current pandemic and in future ones. This study provides a psychometric evaluation of the General Health Literacy Scale (GHLS) and the Health Consciousness Scale (HCS) and further examines their association with conventional COVID-19 preventive behaviors. Confirmatory factor analyses evaluated the psychometric properties of GHLS and HCS. Four separate hierarchical linear regressions, followed by dominance analyses, estimated the relative importance of health literacy and health consciousness on COVID-19 preventive behaviors, adjusting for sociodemographic characteristics. Both GHLS and HCS achieved adequate psychometric criteria, and holding constant sociodemographic characteristics, positively related to COVID-19 preventive behaviors. Although both health literacy and health consciousness were more important than sociodemographic characteristics in explaining COVID-19 preventive behaviors, health consciousness was most important, exceeding the explanatory power of health literacy in all regressions. COVID-19 public health campaigns that seek to raise health awareness among Hispanic people might prove more effective than campaigns that only seek to improve their health literacy.

Community behavioral change and management of COVID-19 Pandemic: Evidence from Indonesia

Objectives

This study aims to investigate the effect of information and motivation on behavioral change related to the COVID-19 pandemic management in Indonesia. It also examines the role of behavioral skills in mediating the information-behavioral change relationship and the motivation-behavioral change relationship.

Method

This study employs the partial least squares structural equation modeling (PLS-SEM) to test the research hypotheses. Using the online survey method to collect data, 845 responses were obtained from several main islands of Indonesia.

Results

The results of the study show that information and motivation positively influence people's behavior changes. Behavioral skills mediate the influence of information and motivation on behavioral change. This study contributes to the development of the information-motivation-behavior model (IMB-Model). It also provides additional knowledge on pandemic management in the research setting of Indonesia as a country that has complex characteristics in terms of religion and belief, demography, culture, economy, and politics.

Conclusions

This study concludes that the success of Indonesia in dealing with the pandemic greatly depends on the success of changing the community behavior. Providing reliable and consistent information enhances people's motivation to build their behavioral skills. With increased behavioral skills, people have changed their behavior in fighting against COVID-19 by obeying health protocols, participating in vaccination programs, and practicing a healthier lifestyle.

High-risk sexual behaviours in young people experiencing a first episode of psychosis

AIM

The sexual health of adults with schizophrenia is poorer than the general population; however, less is known about young people experiencing a first episode of psychosis (FEP). The aim of this study was to explore the high-risk sexual behaviours and sexual well-being indicators of a cohort of young people with FEP.

METHODS

Data collected from young people (15-24 years) with FEP attending the EPPIC service in Melbourne and participating in a physical health intervention were analysed. Baseline trial data collected on sexual health and high-risk behaviours, psychiatric symptomology, functioning, and substance use are presented by gender. Associations between symptomology and functioning with sexual behaviour are explored.

RESULTS

A total of 69 young people were included in this study; mean age was 19.6 years (SD±2.8), 53.6% were male, 59.6% identified as heterosexual, and 21.7% were currently in a relationship. Within the cohort, 78.3% had ever been sexually active. Of these, 44.2% consistently used a condom at last sex act and 35.7% used barrier contraception consistently, 22.5% had previously been pregnant, and 18.6% had tested positive for an STI. Finally, young people were more likely to have been sexually active if they were currently using substances.

CONCLUSIONS

These findings suggest that high rates of high-risk sexual behaviour remain an issue for young people experiencing a first episode of psychosis. Promoting sexual well-being and communication skills between sexual partners should be targeted to ensure that high-risk sexual health outcomes are mitigated as early as possible.

Factors Influencing Performance of Exercise Behavior of Middle-Aged Men with Chronic Disease Based on the Information-Motivation-Behavioral Skill-Revealed-Related Variables (IMBR) Model

The purpose of this study was to analyze the factors influencing performance of exercise behavior of middle-aged men with chronic disease by adding variables through literature to the Information-Motivation-Behavioral skill model. Subjects of this study are total 171 people belonging to exercise clubs. In the results of putting the control variable in the step-1 of the hierarchical regression analysis, the health condition, smoking, the number of exercises per week, and hours of each exercise were revealed as influence factors and showed 38.4% explanatory power on the performance of exercise behavior. In the results of putting the factors required for behavioral change in the step-2 analysis, the information for exercise, motivation for exercise, sport commitment, and perceived barriers to exercise were influence factors, showing 60.1% explanatory power on the performance of exercise behavior. In the results of putting the exercise self-efficacy of exercise behavioral skills in the step-3 analysis, it was revealed as an influence factor that showed 63.0% explanatory power. Regarding the influence on participants' exercise behavior, the factors required for behavioral change and behavioral skill factors were relatively more important than the general characteristics. This study suggests application of IMBR model to the program for exercise behavior.

A Review of Digital Interventions to Decrease Cannabis Use Among Patients With Comorbid Psychiatric Disorders

OBJECTIVE

Cannabis use disorder (CUD) is associated with an elevated risk for psychiatric disorders and symptoms, contributing to poor health outcomes and increased medical costs. Unfortunately, interventions that simultaneously address cannabis use and co-occurring psychiatric disorders are limited in availability. Targeted digital interventions to reduce cannabis use could be beneficial for patients with psychiatric disorders. Digital interventions could be easily disseminated and used in numerous clinical locations, including outpatient, inpatient, residential, and community psychiatric treatment settings.

METHODS

Literature on digital cannabis reduction interventions for persons with psychiatric disorders was examined between April 2021 and June 2021. Articles were obtained from PubMed and PsycINFO databases. English language randomized controlled trials (RCT), feasibility and acceptability studies, pilot studies, and published protocols were included.

RESULTS

There is significant evidence that digital interventions can effectively reduce cannabis use in general, non-clinical populations. However, there is less literature examining interventions for persons living with co-occurring psychiatric illness-most of which is tailored to patients living with chronic psychosis.

CONCLUSIONS

There is great need for accessible and tailored digital interventions for co-occurring CUD and psychiatric disorders.

The Information-Motivation-Behavioral Skills Model and Unprotected Sex: Assessing the Model's Utility and Predictability Among Bar Patrons in Tshwane, South Africa

The Information-Motivation-Behavioral skills (IMB) model has been a useful tool for understanding sexual risk behavior. However, its utility in predicting sexual risk behaviors among bar patrons, for whom the bar setting poses a higher risk of alcohol-related sexual risk behavior, has been underexplored. We assessed (1) the extent to which the IMB predicted number of episodes of unprotected sex in the past six months and (2) whether incorporating sex under the influence of alcohol and alcohol use improved the predictability of the model among bar patrons. Hierarchical regression models were conducted on data from 406 men and women from bars in rural areas of North-West province, South Africa. Behavioral skills were the sole IMB variable to predict unprotected sex with main partners (β = - 0.40; p < .001), explaining 18% of the variance. Variance explained increased to 21% with addition of sex under the influence of alcohol (β = 0.13; p = .019) and further increased to 26% with the addition of alcohol use (β = 0.24; p < .001). Motivation (β = - 0.21; p = .006) and behavioral skills (β = - 0.21; p = .006) were the significant IMB predictors of unprotected sex with casual partners (explaining 15% of the variance). Variance explained increased to 22% with the addition of sex under the influence of alcohol (β = 0.26; p = .001), but alcohol consumption was not an independent predictor of episodes of unprotected sex with casual partners. Interventions for improving HIV prevention behaviors among bar patrons should focus on enhancing individuals' behavioral skills and motivation and reducing their alcohol consumption.

Assessing Determinants of Online Medical Services Adoption Willingness of General Hospital Physicians Using the Information-Motivation-Behavioral Skills Model: A Multi-Group Structural Equation Modeling Approach

Purpose

Physician adoption of online medical services (OMS) has been hastened by the COVID-19 pandemic, but their adoption willingness still requires to be improved. This study aims to construct a physician’s OMS adoption willingness model based on the information-motivation-behavioral skill (IMB) theory, explore the determinants affecting adoption willingness and its influencing pathways, and evaluate the moderating effects of OMS use experience on willingness through multi-group analysis.

Participants and Methods

A cross-sectional survey was conducted among physicians in three public hospitals of Jiangsu province, China, from June to July 2020, using a multi-stage sampling method. Structural equation modeling was applied to analyze the valid data from 531 respondents.

Results

Physicians’ willingness to adopt OMS was at a moderate level, with an average score of 14.27±3.34 (range: 4–20). The behavior model for physician’s OMS adoption willingness fitted well. Information (In), motivation (Mo), and behavioral skill (BS) explained 69% of the variance in adoption willingness (AW). Information could only exert completely indirect effect on willingness via behavioral skills (b = 0.202, 95% CI[0.122, 0.314]); motivation could both generate direct effect (β=0.368, p < 0.001) and partial indirect effect on willingness via behavioral skills (b = 0.160, 95% CI[0.092, 0.248]); and behavioral skills had a positive effect on willingness (β=0.424, p < 0.001). Furthermore, OMS use experience showed a significant moderating effect on the Mo → AW pathway, with inexperienced physicians’ willingness being significantly stronger influenced by motivation compared to experienced ones.

Conclusion

Findings from this study revealed the role of IMB model in interpreting and predicting physicians’ willingness to adopt OMS and the moderating effect of uptake experience, providing practitioners with a theoretical foundation and intervention framework for supporting OMS development efforts.

The importance of information, motivation, and behavioral skills (IMB): Healthcare provider perspectives on improving adherence to cervical cancer screening among at-risk women

Objective

To understand the theoretical framework of how information, motivation, and behavioral skills (IMB) independently and collectively affect cervical cancer screening and testing adherence.

Study design

Qualitative study.

Methods

Data collected from three focus groups and seven individual interviews, with 33 healthcare providers, ranging from community health navigators, Ob-Gyn MD’s, nurses, care coordinators, medical assistants, and outpatient managers, representing a grassroots community health agency, a large cancer center, and a public sector health clinic. We recruited providers over a five-month period in the summer to fall of 2019. Provider interviews and focus groups were structured with four to eleven participants per group and were audio-recorded. This study was rooted in grounded theory, analyzing data using the iterative process of Coding, Consensus, Co-occurrence, and Comparison to identify common themes.

Results

Emerging qualitative findings include the relevance of information, the interaction between information and motivation, the role of behavioral skills, and the symbiotic relationship between information, motivation, and behavioral skills (IMB). Most notable is this interdependency between IMB components, with the core of this relationship being the critical link of coordinating adherence.

Conclusion

This knowledge will help advance and expand IMB intervention components to improve time to cervical cancer screening and follow-up adherence among at-risk communities. Particularly given COVID-19 barriers, which disproportionately affect at-risk women, this study has practice implications that inform the development of cervical cancer screening practice interventions and strategies to improve adherence, while ensuring safety for both patients and providers.

Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions

Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.

Factors influencing health behaviours during the coronavirus disease 2019 outbreak in China: an extended information-motivation-behaviour skills model

OBJECTIVES

This study explored the factors influencing health behaviours during the coronavirus disease 2019 (COVID-19) outbreak in China. The impact of perceived stress and positive perception of interventions on health behaviours in China were assessed using the extended information-motivation-behaviour skills (IMB) model.

STUDY DESIGN

Cross-sectional survey.

METHODS

The Questionstar online survey tool was used to construct a structured questionnaire based on the IMB model. Between 14 and 22 February 2020, during the peak of COVID-19 epidemic in China, 2449 participants were recruited by snowball sampling on WeChat and Tencent QQ social media platforms in China. Data were collected through an online questionnaire, and structural equation modelling was performed to evaluate the extended IMB model.

RESULTS

Health behaviours were assessed using a scoring system (total score range: 8-40); the average health behaviour score in this study was 34.62 ± 4.44. The term 'health risk stress' refers to the impact that perceived stress has on health, and this was experienced by 39.9% of participants. Only 35.9% of participants answered all seven questions on COVID-19 information correctly. The final model showed that information, motivation, behavioural skills, heath risk stress and positive perception of interventions had significant direct effects on health behaviours. Health behaviours were positively associated with the positive perception of interventions but negatively associated with health risk stress. Behavioural skills had the greatest impact on health behaviours.

CONCLUSIONS

In the face of public health emergencies, the extended IMB model has been used as a theoretical framework to construct more effective interventions. The government should pay attention to publicity and guidance, strengthen positive interactions with the public and disclose relevant information in a timely manner to gain trust and to maintain the positive public perception of the interventions. In terms of health education, the government should focus on behavioural skills, promptly rectify ineffective prevention information and raise awareness about the disease to relieve stress and anxiety in the population.

Willingness to Distribute HIV Self-Testing Kits to Recent Sex Partners Among HIV-Negative Gay and Bisexual Men and an Examination of Free-Response Data from Young Men Participating in the Nationwide Cohort

Sexual minority men (SMM)-and young SMM in particular-are disproportionately affected by HIV. Secondary distribution of HIV self-testing (HIVST) kits-wherein patients deliver kits to partners-is a novel strategy to increase HIV testing access. Using quantitative data, we assessed willingness to distribute HIVST kits to recent sex partners among a U.S. national sample of HIV-negative SMM (n = 786). A thematic analysis was then conducted to identify barriers and facilitators of kit distribution to partners among young SMM (M age = 25.75 years; range: 20-29; n = 165). Overall, 93.5% of SMM (and 97.0% of young SMM) were willing to deliver HIVST kits to recent sex partners. Among young SMM, main barriers and facilitators included concerns about their partners' reaction, availability and cost, protection beliefs for others, HIV stigma and perceived infidelity, packaging and support, communication skill needs, inability to contact partners, requests for anonymity, and dyadic self-testing with their partners. The findings highlight the need for supportive intervention strategies such as informational content for HIVST, using motivational interviewing when providing the testing kits to index clients and providing skills-based training through role-playing exercises. Secondary distribution of HIVST kits through index patients is a potentially acceptable approach that could be used to expand access to HIV testing and aid in efforts to end the HIV epidemic in the U.S.

Testing the Interpersonal-Behavior model to explain intentions to use patient-delivered partner therapy

Background

Patient-delivered partner therapy (PDPT) is an evidence-based method of partner treatment, but further research was needed to understand theoretical underpinnings of potential PDPT use.

Purpose

We sought to develop and test a theoretical framework to understand PDPT intentions.

Methods

A Midwestern sample of sexually transmitted infection clinic patients were recruited to participate in a three-phase study incorporating semi-structured interviews (n = 20, total), cognitive interviews (n = 5), and surveys (n = 197; M_age = 31.3, 61% male, 91% Black or African-American). Thematic analysis was conducted to identify major themes, which guided development and testing of a theoretical framework on PDPT intentions using structural equation modeling.

Results

We identified themes of information (knowledge); motivation (individual and partner protection beliefs, partner and provider motivation-to-comply); social support (sexual health and general); and behavioral skills (partner notification, medication delivery, and communication skills self-efficacy) in thematic analysis. The developed Interpersonal-Behavior model demonstrated good model fit in structural equation modeling [χ2(36) = 95.56, p<0.01; RMSEA = 0.09 (0.07–0.11, 90%C.I.); CFI = 0.94; SRMR = 0.05]. Information was associated with motivation (β = 0.37, p<0.001) and social support (β = 0.23, p = 0.002). Motivation was associated with social support (β = 0.64, p<0.001) and behavioral skills (β = 0.40, p<0.001), and social support was associated with behavioral skills (β = 0.23, p = 0.025). Behavioral skills were associated with higher PDPT intentions (β = 0.31, p<0.001), partially mediated the association of motivation with intentions (β_direct = 0.53, p<0.001; β_indirect = 0.12, 95%CI: 0.03–0.30), and fully mediated the association of social support with intentions (β_indirect = 0.07, 95%CI: 0.00–0.21).

Conclusions

The Interpersonal-Behavior model seems appropriate for PDPT intentions but should be tested longitudinally with PDPT outcomes and other interpersonal health behaviors.

Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College

The present study examined the mediating role of sexual assertiveness in the relationship between psychological, physical, and sexual intimate partner violence (IPV) victimization and unprotected sex as a result of condom use resistance among sexually active young women attending community college. Women reported engagement in unprotected sex as a result of a partner's use of one of 32 forms of condom use resistance (e.g., physical force, deception, or other forms of coercion to avoid using a condom during intercourse). Women ages 18-24 years (N = 212) attending community college were recruited through paper advertisements to complete assessments of social and dating behavior in the campus computer laboratory. Only the women with a history of sexual intercourse (N = 178; 84% of the sample) were included in analyses. More frequent engagement in unprotected sex as a result of a partner's condom use resistance was associated with physical, psychological, and sexual IPV victimization. Sexual assertiveness mediated the relationship between physical IPV victimization and the frequency of unprotected sex as a result of condom use resistance. Efforts to prevent dating violence and enhance the sexual health of community college women may benefit from focusing on targeting sexual assertiveness as a protective factor.

Towards an Information Motivation and Behavioral Skills Model for New Sex Partners: Results of a Study of Condom Use as an HIV Prevention Method for Emerging Adults Who Met Partners on Dating and Sex-Seeking Platforms or Offline

The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants' IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners.

Evaluating the Impact of a Targeted Brief HIV Intervention on Multiple Inter-Related HIV Risk Factors of Knowledge and Attitudes among Incarcerated Drug Users

Increases in HIV prevalence indicate ongoing need for HIV interventions. A brief manualized intervention called TCU WaySafe, which addresses multiple HIV risks, was further evaluated to determine how it addressed individual's knowledge deficiencies in the assessed risks. The sample of 1256 offenders in 8 correctional substance abuse treatment programs participated either in treatment as usual (TAU) or TCU WaySafe. From multivariate multi-level analysis, WaySafe was more effective in improving the greatest need area, whether knowledge, motivation, or confidence regarding HIV risky behaviors. Findings underscored the importance of addressing HIV risk areas with greatest need for change and strengthens previous findings of the intervention's potential for individuals with varying HIV risks.

Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model

Background

Men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection in China. Correct and consistent condom use is one of the most effective strategies for preventing the spread of HIV. This study developed a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behavior among Chinese MSM.

Methods

A cross-sectional study was conducted to collect data using self-administered electronic questionnaire. Participants were recruited from HIV Voluntary Counseling and Testing clinics in six district Centers for Disease Control and Prevention in Guangzhou and two community-based HIV service centers (Lingnan Partners and Zhitong Charity) from May to September 2017. Structural equation modeling was performed to develop the modified IMB model with extended multilevel factors.

Results

Among the 976 MSM included, 52.05% had engaged in anal intercourse with a condom every time. The final modified IMB model fitted the data more ideally than the conventional model. The final modified IMB model revealed that behavioral skills positively contributed directly to condom use (β = 0.385, p < 0.001) and partially mediated the associations between information (β = 0.106, p = 0.005) and motivation (β = 0.390, p < 0.001) and condom use. Regarding the extended multilevel factors, education, income, receiving HIV prevention services, sexual partner seeking behavior, depression, intimate partner violence, and child sexual abuse had indirect impacts on condom use that were mediated by information, motivation, and/or behavioral skills (p < 0.05). All paths from the latent variable to the corresponding observed variables were statistically significant (p < 0.001).

Conclusion

The modified IMB model with extended multilevel factors could serve as a theoretical framework for behavioral interventions for condom use among Chinese MSM. Further prospective studies are needed to examine the predictive power of the modified IMB model.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6593-8) contains supplementary material, which is available to authorized users.

Decisional Balance and Contemplation Ladder to Support Interventions for HIV Pre-Exposure Prophylaxis Uptake and Persistence

Fewer than 60,000 males-inclusive of all sexual identities-were prescribed HIV pre-exposure prophylaxis (PrEP) by mid-2017 in the United States. Efforts to increase PrEP uptake among gay, bisexual, and other men who have sex with men (GBM), in particular, are ongoing in research and practice settings, but few tools exist to support interventions. We aimed to develop and validate tools to support motivational interviewing interventions for PrEP. In 2017, a national sample of HIV-negative GBM of relatively high socioeconomic status (n = 786) was asked about sexual behaviors that encompass Centers for Disease Control and Prevention guidelines for PrEP use, a 35-item decisional-balance scale (i.e., PrEP-DB) assessing benefits and consequences of PrEP use, and questions assessing location on the motivational PrEP cascade and derivative-the PrEP contemplation ladder. Principal axis factoring with oblique promax rotation was used for PrEP-DB construct identification and item reduction. The final 20-item PrEP-DB performed well; eigenvalues indicating a 4-factor solution provided an adequate fit to the data. Factors included the following: health benefits (α = 0.91), health consequences (α = 0.82), social benefits (α = 0.72), and social consequences (α = 0.86). Ladder scores increased across the cascade (ρ = 0.89, p < 0.001), and health benefits (β = 0.50, p < 0.001) and health consequences (β = -0.37, p < 0.001) were more strongly associated with ladder location than social benefits (β = 0.05, p > 0.05) and social consequences (β = -0.05, p > 0.05) in the fully adjusted regression model. The PrEP-DB demonstrated good reliability and predictive validity, and the ladder had strong construct validity with the motivational PrEP cascade. PrEP uptake and persistence interventions and additional empirical work could benefit from the utility of these measures.

Addressing missed opportunities for HIV testing by including rapid-HIV self-testing kits with patient-delivered partner therapy

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with bacterial sexually transmitted infections (STIs) medication to give directly to their partner for treatment, which can result in missed opportunities for partner HIV testing. Fifteen STI clinic patients were asked about their opinions of including HIV self-testing (HIVST) kits with PDPT. Interview data fit well into constructs of the information-motivation-behavioral skills (IMB) model. Patients' motivations to deliver HIVST kits to their partners included the importance of earlier identification of HIV, convenience, avoidance of STI clinic stigma, and empowerment of individual and partner protection against HIV. Patients described the need for more information with worries about the quality of the HIVST device and questions about how it worked. Patients worried about their partners' reaction, including the potential for violence, and needed skills to support their partner with HIVST. Public health policies should support the inclusion of HIVST kits with PDPT, but additional intervention research is needed to more fully support patients and their partners with HIVST and PDPT.

Strength of Implementation Intentions to Use Condoms Among Men Who Have Sex with Men

Although pre-exposure prophylaxis (PrEP) use is increasing among men who have sex with men (MSM), condoms remain key to HIV prevention. Implementation intentions-which link a behavioral action plan with a situation or cue-may predict condom use. The Strength of Implementation Intentions Scale (SIIS), which assesses condom use implementation intentions, has not been evaluated among MSM. A structural model tested whether the SIIS mediated the relationship between condom use intentions and condomless sex acts among 266 sexually-active MSM (56% White, 26% Black, 15% Latino, M_age = 32.54). After controlling for PrEP use, HIV-status, and demographics (χ²(107) = 140.06, CFI = 0.98, TLI = 0.97, RMSEA = 0.03), the SIIS fully mediated the relationship between condom use intentions and condomless sex acts. The SIIS can serve as a fidelity check for interventions, a mediator in theoretical models, and future studies should incorporate implementation intentions into HIV prevention interventions for MSM.

Adherence to pre-exposure prophylaxis among men who have sex with men: A prospective cohort study

OBJECTIVE

To evaluate adherence to pre-exposure prophylaxis (PrEP) in a clinical trial of a population of men who have sex with men (MSM), to explore the influence of social psychology and objective factors (e.g., forgetting, too busy) on adherence, and to provide evidence for subsequent PrEP research.

METHODS

This study analyzed the data from the daily medication group within a PrEP study (a randomized placebo-controlled trial of oral tenofovir among MSM in Western China from April 2013 to March 2015). A total of 331 participants were analyzed. PrEP adherence was self-reported by the subjects at every 3-month follow-up visit for 24 months. AIDS-related information including HIV prevention, transmission, and treatment knowledge, as well as PrEP-related motivation (including personal and social motivation) and behavior skills, i.e., self-efficacy, were collected using questionnaires. The objective reasons for non-adherence were collected during face-to-face follow-up visits every 3 months. A theoretical model of information motivation behavior skills (IMB) was constructed. Then confirmatory factor analysis was performed to test the fit of each IMB construct. Finally, the structure equation model was used to evaluate the IMB model.

RESULTS

The median adherence rate was 64.29%. During the follow-up period, the percentage of high adherence (adherence ≥80%) was 32.33%, intermediate adherence (adherence 40-80%) was 38.97%, and low adherence (adherence ≤40%) was 28.70%. The final IMB model showed that there was no significant correlation between adherence to PrEP and the psychological constructs: information, motivation, and behavior skills. The main objective reasons for non-adherence were 'forgetting to take medicine' (70.21%), 'too busy' (29.08%), 'worrying about side effects' (28.01%), and 'too much trouble' (18.44%).

CONCLUSIONS

This study found no association between PrEP adherence and social psychological factors, and the main objective factor in non-adherence was forgetting to take the medicine. In the future, the MSM population could be reminded to take their medicine regularly using electronic devices, which may improve PrEP adherence to some extent and may further reduce the incidence of HIV. The strategy to improve PrEP adherence requires further study.

Testing the Efficacy of Combined Motivational Interviewing and Cognitive Behavioral Skills Training to Reduce Methamphetamine Use and Improve HIV Medication Adherence Among HIV-Positive Gay and Bisexual Men

Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12 months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.