Abstract
PrEP is an effective daily prevention medicine used to reduce risks of HIV infections. Previous research has pointed out the intention–behavior gap on PrEP uptake among gay men. The current study built on research examining how the integrative model of behavioral prediction (IMBP) factors influences PrEP uptake among gay men to explore how actual control variables, namely skills and environmental constraints, moderated the intention–behavior relationship. We used results from formative interviews to construct a survey and collected data from 420 gay men. Results showed several factors that were associated with PrEP uptake among gay men. Specifically, the lack of access to an LGBTQ-friendly healthcare provider(s) and lack of English fluency had significant main effects on PrEP uptake behavior, while lack of access to a healthcare provider and lack of healthcare system knowledge were significant moderators of the intention–behavior relationship. This study advances our understanding of the IMBP and offers practical implications for PrEP promotion. Limitations and suggestions for future studies are discussed.
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References
AIDSVu. (2019). Mapping PrEP: First-ever data on PrEP users across the U.S. Retrieved March 15, 2019, from https://aidsvu.org/prep/.
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action-control: From cognition to behavior (pp. 11–39). Heidelberg, Germany: Springer.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Process, 50, 179–211.
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40(4), 471–499. https://doi.org/10.1348/014466601164939.
Arnold, T., Brinkley-Rubinstein, L., Chan, P. A., Perez-Brumer, A., Bologna, E. S., Beauchamps, L., et al. (2017). Social, structural, behavioral and clinical factors influencing retention in pre-exposure prophylaxis (PrEP) care in Mississippi. PLoS ONE. https://doi.org/10.1371/journal.pone.0172354.
Boas, T. C., Christenson, D. P., & Glick, D. M. (2020). Recruiting large online samples in the United States and India: Facebook, Mechanical Turk, and Qualtrics. Political Science Research and Methods, 8(2), 232–250. https://doi.org/10.1017/psrm.2018.28.
Byers, E. S., & Sears, H. A. (2012). Mothers who do and do not intend to discuss sexual health with their young adolescents. Family Relations, 61(5), 851–863.
Cahill, S., Taylor, S. W., Elsesser, S. A., Mena, L., Hickson, D., & Mayer, K. H. (2017). Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in Black compared to White gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care, 29(11), 1351–1358. https://doi.org/10.1080/09540121.2017.1300633.
Carey, M. P., & Schroder, K. E. E. (2002). Development and psychometric evaluation of the Brief HIV Knowledge Questionnaire. AIDS Education and Prevention, 14(2), 172–182. https://doi.org/10.1521/aeap.14.2.172.23902.
Centers for Disease Control and Prevention. (2016). Pre-exposure prophylaxis (PrEP). Retrieved March 15, 2019, from https://www.cdc.gov/hiv/risk/prep/.
Centers for Disease Control and Prevention. (2017). STDs in men who have sex with men—2016 STD surveillance report. Retrieved March 15, 2019, from https://www.cdc.gov/std/stats16/msm.htm.
Dai, M. (2019). Using the integrative model of behavioral prediction to understand gay men’s beliefs, intention, and behavior on prep uptake [Doctoral dissertation, University of Kentucky]. UKnowledge database. https://doi.org/10.13023/etd.2018.438.
Dai, M., & Cohen, E. (2016). Exploring the diffusion of HIV testing among the high-risk male-seeking-male population. Paper presented at the Western Communication Association Conference, San Diego, CA.
Duke, C. C., & Stanik, C. (2016). Knowledge is power: Improving health care information for the most vulnerable. Health Affairs. https://doi.org/10.1377/hblog20160525.055033/full/.
Eaton, L. A., Driffin, D. D., Bauermeister, J., Smith, H., & Conway-Washington, C. (2015). Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, Black men who have sex with men. AIDS Patient Care & STDs, 29(8), 423–429. https://doi.org/10.1089/apc.2014.0303.
Fishbein, M. (2000). The role of theory in HIV prevention. AIDS Care, 12, 273–278.
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior. New York: Psychology Press.
Fitzsimons, T. (2018, May 30). With TV ads, drugmaker Gilead brings HIV prevention drug out of the closet. NBC News. Retrieved March 15, 2019, from https://www.nbcnews.com/feature/nbc-out/tv-ads-drugmaker-gilead-brings-hiv-prevention-drug-out-closet-n878721.
Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R. D., Bowling, J., … Reece, M. (2014). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the United States. LGBT Health, 1(4), 309–318. https://doi.org/10.1089/lgbt.2014.0005.
Gilead Sciences. (2018). Gilead launches a national television advertising campaign to increase public awareness of Truvada for PrEP® (Emtricitabine and Tenofovir Disoproxil Fumarate) as an HIV prevention option. Retrieved March 15, 2019, from http://gileadhivmedia.com/#restoftext.
Heen, M. S. J., Lieberman, J. D., & Miethe, T. (2014). A comparison of different online sampling approaches for generating national samples. Center for Crime and Justice Policy at University of Nevada at Las Vegas. https://doi.org/10.13140/RG.2.2.24283.62243.
Highleyman, L. (2016). PrEP use is rising fast in the U.S., but large racial disparities remain. Retrieved May 10, 2017, from http://www.aidsmap.com/PrEP-use-is-rising-fast-in-US-but-large-racial-disparities-remain/page/3065545.
Macapagal, K., Kraus, A., Korpak, A. K., Jozsa, K., & Moskowitz, D. A. (2020). PrEP awareness, uptake, barriers, and correlates among adolescents assigned male at birth who have sex with males in the U.S. Archieves of Sexual Behavior, 49, 113–121. https://doi.org/10.1007/s10508-019-1429-2.
McLaughlin, M. L., Hou, J., Meng, J., Hu, C., An, Z., Park, M., & Nam, Y. (2016). Propagation of information about preexposure prophylaxis (PrEP) for HIV prevention through Twitter. Health Communication, 31(8), 998–1007. https://doi.org/10.1080/10410236.2015.1027033.
Newport, F. (2018). In the U.S., an estimate of the LGBT population rises to 4.5%. Gallup News. Retrieved March 15, 2019, from https://news.gallup.com/poll/234863/estimate-lgbt-population-rises.aspx.
Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J. A., Nielsen-Bohlman, L. T., & Rudd, R. R. (2005). The prevalence of limited health literacy. Journal of General Internal Medicine, 20(2), 175–184. https://doi.org/10.1111/j.1525-1497.2005.40245.x.
Rios-Zertuche, D., Cuchilla, J., Zúñiga-Brenes, P., Hernández, B., Jara, P., Mokdad, A. H., & Iriarte, E. (2017). Alcohol abuse and other factors associated with risky sexual behaviors among adolescent students from the poorest areas in Costa Rica. International Journal of Public Health, 62(2), 271–282. https://doi.org/10.1007/s00038-016-0859-z.
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340. https://doi.org/10.1002/1098-240X(200008)23:4%3c334:AID-NUR9%3e3.0.CO;2-G.
Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. Journal of Educational Research, 99(6), 323–338. https://doi.org/10.3200/JOER.99.6.323-338.
Schwartz, J., & Grimm, J. (2016). Uncertainty in online U.S. news coverage of Truvada. Health Communication, 31(10), 1250–1257. https://doi.org/10.1080/10410236.2015.1055051.
Smith, D., Van Handel, M., Wolitski, R., Stryker, Jo, Hall, I., Prejean, J., … Valleroy, L. (2015). Vital signs: Estimated percentages and nuflashmbers of adults with indications for Preexposure Prophylaxis to prevent HIV acquisition: The United States, 2015. Morbidity and Mortality Weekly Report, 64(46), 1291–1295.
Templeton, G. (2011). A two-step approach for transforming continuous variables to normal: Implications and recommendations for IS research. Communications of the Association for Information Systems. https://doi.org/10.17705/1CAIS.02804.
Wilke, M. (2017). PrEP marketing campaigns get homoerotic: It’s about time. Queerty. Retrieved March 23, 2018, from https://www.queerty.com/photos-prep-marketing-campaigns-get-homoerotic-heres-20170408.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research procedures were approved by the Institutional Review Board at the University of Kentucky (IRB# 42322, ID# 3443).
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Dai, M., Harrington, N.G. Intention to Behavior: Using the Integrative Model of Behavioral Prediction to Understand Actual Control of PrEP Uptake Among Gay Men. Arch Sex Behav 50, 1817–1828 (2021). https://doi.org/10.1007/s10508-020-01802-y
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DOI: https://doi.org/10.1007/s10508-020-01802-y