Illness representation of COVID-19 affected public's support and anticipated panic regarding the living with the virus policy: a cross-sectional study in a Chinese general population

Background

There is a global trend for countries to adopt the Living with the Virus (LWV) policy regarding COVID-19. Little is known about the public's supportiveness and emotional responses (e.g., anticipated panic) related to this policy. Such responses may be associated with illness representations of COVID-19 (i.e., how people think and feel about COVID-19). This novel topic was investigated in this study to facilitate policy-making and health communication.

Methods

A random, population-based telephone survey interviewed 500 adults aged ≥18 of the Hong Kong general adult population from March to April 2022.

Results

The prevalence of the public's support and anticipated panic regarding the LWV policy, which were negatively correlated with each other, was 39.6 and 24.2%, respectively. The illness representation constructs of consequences, timeline, identity, illness concern, and emotional representations were negatively associated with supportiveness and positively associated with anticipated panic regarding the LWV policy. Illness coherence was significantly associated with policy support but not with anticipated panic. The associations between personal control/treatment control and supportiveness/anticipated panic were statistically non-significant. Moderation analyses showed that the above significant associations were invariant between those with and without previous COVID-19 infection.

Conclusion

Policymakers need to be sensitized about the public's supportive/unsupportive attitude and potential worry (panic) when adopting the LWV policy. Such attitudes/emotional responses may be affected by people's illness representations of COVID-19. In general, those who found COVID-19 involving a milder nature and less negative emotions would be more supportive and anticipated less panic under the LWV policy.

Factors of COVID-19 Vaccination among Hong Kong Chinese Men Who Have Sex with Men during Months 5–8 since the Vaccine Rollout—General Factors and Factors Specific to This Population

This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19.

Two Web-Based and Theory-Based Interventions With and Without Brief Motivational Interviewing in the Promotion of Human Papillomavirus Vaccination Among Chinese Men Who Have Sex With Men: Randomized Controlled Trial

Background

Human papillomavirus (HPV) vaccination is effective in the prevention of vaccine-type genital warts and cancers among men who have sex with men (MSM).

Objective

The primary objective of this randomized controlled trial (RCT) is to evaluate the efficacies of 2 web- and theory–based interventions with and without brief motivational interviewing (MI) over the phone to increase the completion of HPV vaccination among unvaccinated participants within a 24-month follow-up period compared with the control group.

Methods

A 3-arm parallel-group RCT was conducted between July 2017 and December 2019. Five telephone surveys were conducted at baseline and at 3, 6, 9, and 24 months by blinded interviewers. Participants were Hong Kong Chinese–speaking MSM aged between 18 and 45 years with regular internet access who were recruited from outreaching at venues, web-based recruitment, and peer referral. Those who had ever received HPV vaccination were excluded. A total of 624 participants were randomized into either the online tutorial (OT) only group (n=208), the OT plus MI group (OT-MI; n=208), or the control group (n=208). In total, 459 (459/624, 73.6%) completed the follow-up evaluation at 24 months. Participants in the OT group received a fully automated OT developed based on the health belief model. On top of the same OT, the OT-MI group received brief MI over the phone. Reminders were sent to the participants of the OT and OT-MI groups after 1, 2, 4, 6, and 8 months. Participants in the control group received web-based health communication messages unrelated to HPV or HPV vaccination. The research team validated the self-reported HPV vaccination uptake. Intention-to-treat analysis was used for outcome analyses. Logistic regression models and multivariable linear regression models were used to test the between-group differences in primary and secondary outcomes. Baron and Kenny’s methods were used to test the mediation hypothesis.

Results

The participants in the OT-MI group reported a significantly higher validated completion of HPV vaccination at 24 months than the control group (36/208, 17.3% vs 15/208, 7.2%; P=.006). However, the difference in HPV vaccination completion between the OT and the control groups (24/208, 11.5% vs 15/208, 7.2%; P=.17), or between OT-MI and OT groups (P=.13), was not statistically significant. The association between randomization status (OT-MI group vs control group) and HPV vaccination completion became statistically nonsignificant after controlling for changes in the perceived susceptibility to HPV (24 months vs baseline), whereas perceived susceptibility remained strongly associated with HPV vaccination uptake in the model (P<.001). Changes in perceived susceptibility fully mediated the intervention effect.

Conclusions

Theory-based OT with brief MI over the phone was effective in increasing HPV vaccination completion among Chinese MSM. Perceived susceptibility is an active theoretical component that causes behavioral changes.

Trial Registration

ClinicalTrials.gov NCT03286907; https://clinicaltrials.gov/ct2/show/NCT03286907

Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study

Background

Sexualized drug use (SDU; the use of any psychoactive substance before or during sexual intercourse) is prevalent among men who have sex with men (MSM) and may aggravate the worsening HIV epidemic in this key population.

Objective

This observational prospective cohort study investigated factors predicting the occurrence of SDU within a 6-month follow-up period among a sample of MSM in Hong Kong. We hypothesized that perceptions related to SDU would mediate the association between the influence of social media/gay social networking apps and SDU during the follow-up period.

Methods

Participants were Chinese-speaking men in Hong Kong, China who had anal intercourse with at least one man in the past year. Among 600 participants who completed the baseline telephone survey, 407 (67.8%) completed another telephone survey 6 months later. Logistic regression models and path analysis were fitted.

Results

At Month 6, 6.9% (28/407) and 4.4% (18/407) of participants reported SDU and chemsex during the follow-up period. After adjustment for significant baseline background variables (use of pre-exposure prophylaxis; history of HIV and other sexually transmitted infections; anal intercourse with nonregular male sex partners, condomless anal intercourse with men, multiple male sex partnerships, and SDU at baseline), three constructs of the Theory of Planned Behavior (TPB) were significantly associated with SDU during the follow-up period: (1) positive attitudes toward SDU (adjusted odds ratio [AOR] 1.19, 95% CI 1.05-1.36), (2) perceived support for SDU from significant others (AOR 1.15, 95% CI 1.01-1.30), and (3) perceived behavioral control of refraining from SDU (AOR 0.76, 95% CI 0.59-0.98). Exposure to information supporting SDU on social media and gay social networking apps was also significantly associated with SDU (AOR 1.11, 95% CI 1.01-1.22). Bootstrapping analyses indicated that social media influence was indirectly associated with SDU through TPB-related perceptions of SDU (β=.04; B=.002, 95% CI 0.001-0.01).

Conclusions

Social media and gay social networking apps may be a major source of influence on MSM’s perceptions and actual behaviors related to SDU.