Predicting condom use using the Information-Motivation-Behavioral Skills (IMB) model: a multivariate latent growth curve analysis

Talking to My Partners About PrEP: Factors Associated with PrEP-Related Communication in a Longitudinal US Study of Sexual Minority Men Living with HIV

Treatment as prevention and pre-exposure prophylaxis (PrEP) have reduced HIV transmission among sexual minority men (SMM). However, little is known about PrEP-related communication in serodiscordant partnerships. In 2015-2016, 965 US SMM living with HIV (Mage = 39; 63% White, 19% Black, 18% Latinx) enrolled in a year-long longitudinal study with surveys every 3 months (2,850 surveys). Multilevel models explored factors associated with PrEP-related communication with HIV-negative partners. Most participants (77%) reported PrEP-related communication. Participants were more likely to discuss PrEP during periods with more sexual partners, AOR = 2.89, p < .001, and group sex, AOR = 1.99, p = .001. Those with more partners on average, β = 0.48, p < .001, and those engaging in other drug use more frequently, β = 0.11, p = .002, were more likely to discuss PrEP. PrEP-related communication was more common for men who disclosed their HIV status, β = 0.22, p < .001, and who had undetectable viral loads, β = 0.25, p = .007. Communication was also more common for those with higher incomes, β = 0.12, p = .02, and from larger cities, β = 0.07, p = .048, and less common for Black participants, β =  - 0.29, p = .003, and older participants, β =  - 0.18, p < .001. PrEP-related communication increased over the course of the study, AOR = 1.16, p= .02. PrEP can confer additional HIV prevention benefits within serodiscordant partnerships, and future research should continue to explore the role PrEP plays in these partnerships.

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.

Effects of Information, Motivation, Behavioral Skills Model on Urinary Incontinence in Men With Overactive Bladder and Urge Incontinence: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the effect of an intervention based on and information, motivation, behavioral skills (IMB) model on urinary incontinence symptoms, impact on daily activities, and incontinence-specific quality of life in men with overactive bladder dysfunction (OAB) and urge incontinence.

DESIGN

Parallel-group, open-label, randomized-controlled clinical trial.

SUBJECTS AND SETTING

The sample comprised 60 male patients admitted to the urology clinic of a training and research hospital in Ankara, Turkey. Inclusion criteria were adult men older than 18 years and diagnosed with OAB and urge incontinence.

METHODS

Data were collected from February 2018 to February 2019. Participants were randomized into 2 equal groups. The intervention group (n = 30) received a structured intervention based on the IMB model, and a control group (n = 30) received standard OAB management. The primary outcome was severity of urge incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes were mean scores on the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and Urinary Incontinence Information Rating. All outcome measures were evaluated before and 6 months after the training.

RESULTS

Following the intervention, mean ICIQ-SF scores were significantly lower in the IMB model group as compared to the control group. Analysis revealed a significant increase in knowledge scores in both groups when baseline scores were compared to postintervention scores (P = .000 for the intervention group and P = .004 for the control group). The intervention group participants also had a higher postintervention scores when compared to control group subjects (P = .000).

CONCLUSIONS

A structured behavioral intervention based on the IMB model significantly alleviated the severity of bothersome lower urinary tract symptoms in adult males with OAB and urge incontinence when compared to standard care.

An Examination of Condom Brand's Social Media Influence on Sexual Health Messages

Social media is a primary source of sexual health information for young adults. Increased exposure to sexual health education on social media is associated with safer sexual behavior. Given the diversity of social media accounts, condom brands may be a trusted source of sexual health information. We quantified user interactions on the social media posts of the three most frequently used social media sites of condom brands from January 2020 to June 2021. We analyzed the reach each account had in terms of sexual health information separated into three categories: sexual health education, sexual health resources and social issues relating to sexual health. On Instagram, 48% of posts provide sexual health education, 5% mention resources, and 23% mention social issues. On YouTube 68% of posts provide sexual health education, 35% mention resources, and 31% mention social issues. Providing sexual health education had a positive association with likes on Instagram (n = 923, t = 4.09, p < .001). In terms of sexual health education topics, posts pertaining to reproductive health and sexual self-acceptance were a positive predictor of likes on Instagram (n = 56, t = 7.00, p < .001, n = 77, t = 2.37, p = .015 respectively). Posts pertaining to sex were a positive predictor of likes both on Instagram (n = 74, t = 2.79, p = .005) and YouTube (n = 57, t = 2.21, p = .029). These findings suggest that the sexual health education and resources provided by condom brands have significant reach and positive reception. To promote sexual health to a larger and more receptive audience, future research and education campaigns should recognize and utilize the social media influence of condom brands.

Urban and Rural Disparities of Personal Health Behaviors and the Influencing Factors During the COVID-19 Outbreak in China: Based on an Extended IMB Model

OBJECTIVE

Health behavior was conducive to control the coronavirus disease (COVID-19) epidemic. This study aimed to determine the differences in health behaviors and related factors among rural and urban residents in China.

METHODS

From February 14 to 22, 2020, during the peak of the COVID-19 epidemic in China, a total of 2449 participants (1783 (72.81%) urban residents and 666 (27.19%) rural residents) were recruited by snowball sampling on WeChat and QQ social platforms, both owned by Tencent. Data were collected through the Web-questionnaire guided by an information-motivation-behavioral skills model. The multiple-group structural equation model was applied to analyze the factors.

RESULTS

Rural residents had lower health behavior scores than urban residents, even after adjusting demographic characteristics (33.86 vs 34.29, P = 0.042; total score was 40). Motivational, behavioral skills, and stress had direct positive and negative influences on health behaviors of urban and rural residents. Information and positive perception of interventions had direct effects on health behaviors in rural residents, but not in urban residents. All the factors were mediated by behavioral skills in rural and urban residents.

CONCLUSIONS

This study suggests that the government should pay attention to substantial rural and urban disparities and implement different COVID-19 prevention and intervention policies for health behaviors targeting rural and urban residents.

Information and Motivation Predict HIV-Serostatus Among a Population of High-Risk Men and Transgender Women Who Have Sex with Men

Two constructs from the information-motivation-behavioral skills model were used to predict HIV-serostatus among a sample of men and transgender women who have sex with men. Hypotheses were that lower levels of HIV knowledge and lower levels of motivation to remain HIV-negative would be associated with an increased likelihood of receiving a positive HIV test result at a study eligibility-screening session. Results of a backwards stepwise logistic regression analysis demonstrated that lower levels of HIV knowledge, lower levels of motivation to remain HIV-negative, lower levels of education, and identifying as Hispanic/Latinx were associated with greater odds of receiving a positive HIV test result. These findings are consistent with the broader HIV-prevention literature that demonstrates that information and motivation are fundamental determinants of HIV preventive behavior. This work has implications for informing the development and improvement of HIV-prevention interventions.

Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness Implementation Trial of SMART

BACKGROUND

Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are.

OBJECTIVE

This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART.

METHODS

Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements.

RESULTS

The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing.

CONCLUSIONS

SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03511131; https://clinicaltrials.gov/ct2/show/NCT03511131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19701.

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.

Love My Body: Pilot Study to Understand Reproductive Health Vulnerabilities in Adolescent Girls

BACKGROUND

Sexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use.

OBJECTIVE

This pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health.

METHODS

We conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls.

RESULTS

We iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls.

CONCLUSIONS

Future work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls.

HIV/AIDS-related Knowledge and Behavior among School-attending Afro-Descendant Youths in Ecuador

BACKGROUND OR OBJECTIVES

HIV/AIDS transmission in Ecuador is considered a concentrated epidemic; therefore, there are some studies on high risk groups but there is limited published data regarding the HIV/AIDS risk factors among adolescents of African descent. In this study, we sought to explore the determinants of HIV/AIDS-related knowledge and behavior among afro-descendant youths attending schools in the city of Esmeraldas, Ecuador.

METHODS

A cross-sectional survey among school-attending youths was conducted in Esmeraldas, Ecuador in 2010. Our target population was afro-descendant youths attending the last two years of high school. Thirty public high schools enrolling students in junior and senior years were identified. Outcome data were analyzed in the form of three composite variables. A multivariate linear regression model was built for each outcome.

RESULTS

A total of 213 school-attending afro-descendant youths aged 14 to 21 years old were enrolled in this study. Gender distribution was almost equal with a 1:1.17 male to female ratio. Overall, students in this population scored well in comprehensive knowledge of HIV with 88% having medium or higher knowledge.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Knowledge of HIV and its determinants was medium to high, but knowledge of sexually transmitted diseases was low among afro-descendant Ecuadorian adolescents in our study. Results of this study might be instrumental in facilitating decision-making processes related to the planning, implementation, and evaluation of HIV/AIDS prevention and control strategies in this specific population.

Applying the Information-Motivation-Behavioral Skills Model to Understand PrEP Intentions and Use Among Men Who Have Sex with Men

Research is needed to determine targets for interventions to increase pre-exposure prophylaxis (PrEP) uptake. The Information-Motivation-Behavioral Skills (IMB) model has not been tested for PrEP use among men who have sex with men (MSM). Men and transgender women and men were surveyed at a community event in the Midwest in 2016 (N = 476, 60% White, Mage = 35). New measures assessed PrEP knowledge, attitudes, stigma, descriptive and subjective norms, and intentions, and participants reported on PrEP use. We tested the IMB model for a subsample of HIV-negative MSM and transgender individuals (N = 357) using structural equation modeling. Only 12% of participants used PrEP. New measures performed well and were reliable (αs = 0.83-0.94). Structural models generally supported the IMB model: knowledge, stigma, and self-efficacy were directly associated with use, and attitudes, stigma, and descriptive norms had indirect effects on use via self-efficacy. The IMB model may be useful when developing PrEP interventions for MSM.

Behavioral Interventions to Increase Condom Use Among College Students in the United States: A Systematic Review

Background. Traditional undergraduate college students in the United States are in the age range that experiences the highest rate of sexually transmitted infections (STIs) and are vulnerable to contracting STIs. Increasing condom use among college students is a prevention strategy to reduce the spread of STIs. Aim. The purpose of this systematic review of the literature was to identify behavioral interventions that increased condom use behaviors and/or intentions among college students. Method. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in systematically searching, extracting, appraising, and synthesizing the evidence. A quality assessment was also conducted with the tool provided by the Effective Public Health Practice Project. Results. The initial search yielded 715 records. After critical appraisal, seven articles remained for review. Discussion. Four of the interventions were developed using the three constructs of the information, motivation, and behavioral skills model, and all four found significant increases in condom use or condom use intentions. Additionally, interventions that included modules to increase self-efficacy for condom use, taught participants where to get condoms and how to negotiate condom use with partners, or elicited positive associations (feels) toward condoms saw increased condom use or intention to use condoms.

Assessing consistent condom use among migrant men who have sex with men in Shanghai, China: validation of an information-motivation-behavioural skills model

BACKGROUND

In China, high prevalence of risky sexual behaviours and inequity in health services lead to situations in which migrant men who have sex with men face higher risk of contracting the human immunodeficiency virus. Consistent condom use is a primary means of preventing HIV infection during anal sex among MSM. This study aimed to apply the information-motivation-behavioural skills model to examine the predictors of consistent condom use among migrant MSM in Shanghai, and tested the associations between model constructs.

METHODS

A cross-sectional study was conducted among 412 migrant MSM in Shanghai. Data on HIV-related information, motivation, behavioural skills, and behaviours were collected via structured questionnaires. A structural equation model was used to assess the IMB model.

RESULTS

Of the 412 participants, 4.4% reported HIV-positive status, and prevalence of consistent condom use in the previous 6 months was 44.9%. A restricted IMB model provided an acceptable fit to the data. Behavioural skills were found to directly predict consistent condom use (β = 0.629, P < 0.01). Neither information nor motivation could directly predict consistent condom use (P > 0.05), but motivation predicted it indirectly and was mediated by behavioural skills.

CONCLUSION

The prevalence of consistent condom use was found to be relatively low among migrant MSM in Shanghai. The restricted IMB model was found to be a good predictor of consistent condom use among them. The results of this study indicate that intervention strategies for safer sexual behaviour should not only include information dissemination, but also emphasize motivation and behavioural skills among this population.

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.

The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment

BACKGROUND

Researchers could benefit from methodological advancements to advance uptake of new treatments while also reducing healthcare disparities. A comprehensive determinants framework for healthcare disparity implementation challenges is essential to accurately understand an implementation problem and select implementation strategies.

METHODS

We integrated and modified two conceptual frameworks-one from implementation science and one from healthcare disparities research to develop the Health Equity Implementation Framework. We applied the Health Equity Implementation Framework to a historical healthcare disparity challenge-hepatitis C virus (HCV) and its treatment among Black patients seeking care in the US Department of Veterans Affairs (VA). A specific implementation assessment at the patient level was needed to understand any barriers to increasing uptake of HCV treatment, independent of cost. We conducted a preliminary study to assess how feasible it was for researchers to use the Health Equity Implementation Framework. We applied the framework to design the qualitative interview guide and interpret results. Using quantitative data to screen potential participants, this preliminary study consisted of semi-structured interviews with a purposively selected sample of Black, rural-dwelling, older adult VA patients (N = 12), living with HCV, from VA medical clinics in the Southern part of the USA.

RESULTS

The Health Equity Implementation Framework was feasible for implementation researchers. Barriers and facilitators were identified at all levels including the patient, provider (recipients), patient-provider interaction (clinical encounter), characteristics of treatment (innovation), and healthcare system (inner and outer context). Some barriers reflected general implementation issues (e.g., poor care coordination after testing positive for HCV). Other barriers were related to healthcare disparities and likely unique to racial minority patients (e.g., testimonials from Black peers about racial discrimination at VA). We identified several facilitators, including patient enthusiasm to obtain treatment because of its high cure rates, and VA clinics that offset HCV stigma by protecting patient confidentiality.

CONCLUSION

The Health Equity Implementation Framework showcases one way to modify an implementation framework to better assess health equity determinants as well. Researchers may be able to optimize the scientific yield of research inquiries by identifying and addressing factors that promote or impede implementation of novel treatments in addition to eliminating healthcare disparities.

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.

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.

The Effect of a Text Messaging Based HIV Prevention Program on Sexual Minority Male Youths: A National Evaluation of Information, Motivation and Behavioral Skills in a Randomized Controlled Trial of Guy2Guy

There is a paucity of literature documenting how the constructs of the Information-Motivation-Behavioral Skills (IMB) model are affected by exposure to technology-based HIV prevention programs. Guy2Guy, based on the IMB model, is the first comprehensive HIV prevention program delivered via text messaging and tested nationally among sexual minority adolescent males. Between June and November 2014, 302 14-18 year old gay, bisexual, and/or queer cisgender males were recruited across the US on Facebook and enrolled in a randomized controlled trial testing Guy2Guy versus an attention-matched control program. Among sexually inexperienced youth, those in the intervention were more than three times as likely to be in the "High motivation" group at follow-up as control youth (aOR = 3.13; P value = 0.04). The intervention effect was not significant when examined separately for those who were sexually active. HIV information did not significantly vary by experimental arm at 3 months post-intervention end, nor did behavioral skills for condom use or abstinence vary. The increase in motivation to engage in HIV preventive behavior for adolescent males with no prior sexual experience is promising, highlighting the need to tailor HIV prevention according to past sexual experience. The behavioral skills that were measured may not have reflected those most emphasized in the content (e.g., how to use lubrication to reduce risk and increase pleasure), which may explain the lack of detected intervention impact.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID# NCT02113956.

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.

Can family-centered programing mitigate HIV risk factors among orphaned and vulnerable adolescents? Results from a pilot study in South Africa

Let's Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers' mental health and parenting skills. Twelve Let's Talk groups, each serving approximately 10 families, were piloted by two local community-based organizations in Gauteng and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among participating caregivers and adolescents at baseline and three months post-intervention to explore the potential effects of the program on intermediate outcomes that may support HIV preventive behavior. Specifically, generalized estimation equations were used to estimate average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental health, and family dynamics. Among the 105 adolescents and their 95 caregivers who participated in Let's Talk and completed both surveys, statistically significant improvements were found for adolescents' HIV and condom use knowledge as well as condom negotiation self-efficacy, but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated significantly better mental health at post-test. Adolescent/caregiver connection and communication about healthy sexuality also improved. These preliminary results highlight the potential of HIV prevention interventions that engage caregivers alongside the vulnerable adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is warranted to substantiate these effects and identify their impact on adolescents' risk behavior and HIV incidence.

What messages can foster safer sex among young women? Experimental evidence concerning the role of emotions and moral norms

Through a 2 × 2 × 2 quasi experimental design (N = 254), this research investigated if a social campaign eliciting positive emotions and activating moral norms might enhance condom negotiation skills, intended and estimated condom among young women with or without past sexual experience with casual partners. Emotions had a main effect on one of the six condom negotiation strategies we considered; for most of the other variables an interaction effect with moral norms and/or past behaviour emerged. Concerning estimated condom use, positive emotions worked better than negative ones when moral norms were salient. With respect to negotiations skills, positive rather than negative emotions seemed more effective for women with past causal sexual experience. In women without this kind of experience, positive emotions seemed to work better when moral norms were salient. Moral norms had a main effect on negotiation self-efficacy, but not in the predicted direction: when moral norms were more salient women were found to be less confident about their negotiation ability. These results suggest that a message which makes moral norms salient should at the same time elicit positive emotions in order to be effective; moreover, messages should be carefully tailored according to women's past behaviour.

Evaluating HIV Knowledge Questionnaires Among Men Who Have Sex with Men: A Multi-Study Item Response Theory Analysis

Knowledge about the transmission, prevention, and treatment of HIV remains a critical element in psychosocial models of HIV risk behavior and is commonly used as an outcome in HIV prevention interventions. However, most HIV knowledge questions have not undergone rigorous psychometric testing such as using item response theory. The current study used data from six studies of men who have sex with men (MSM; n = 3565) to (1) examine the item properties of HIV knowledge questions, (2) test for differential item functioning on commonly studied characteristics (i.e., age, race/ethnicity, and HIV risk behavior), (3) select items with the optimal item characteristics, and (4) leverage this combined dataset to examine the potential moderating effect of age on the relationship between condomless anal sex (CAS) and HIV knowledge. Findings indicated that existing questions tend to poorly differentiate those with higher levels of HIV knowledge, but items were relatively robust across diverse individuals. Furthermore, age moderated the relationship between CAS and HIV knowledge with older MSM having the strongest association. These findings suggest that additional items are required in order to capture a more nuanced understanding of HIV knowledge and that the association between CAS and HIV knowledge may vary by age.

Toward the Tailoring of Sexual Health Education Messages for Young Women: A Focus on Tourist Experiences

Perceived anonymity and decreased influence of sexual double standards in tourism provide female travelers with opportunities for sexual experimentation and risk taking. The purpose of this study was (a) to identify the clusters of risk takers among young women based on their perceptions of and motivations for sexual risk taking in tourism and (b) to profile the clusters with respect to the psychological, sexual, demographic, and tourist characteristics. The data were collected through an online survey of 853 women (age in years: M = 23.5, SD = 6.67). Five clusters of sexual risk takers emerged based on their factor-analyzed risk perceptions and motivations. These clusters were interpreted as (a) diversely motivated broad risk perceivers; (b) fun-seeking broad risk perceivers; (c) diversely motivated physical risk perceivers; (d) anonymity- and empowerment-seeking risk disregarders; and (e) unmotivated broad risk perceivers. Women in these clusters differed in their intentions to engage in sexual risk taking in tourism, sensation-seeking propensities, perceptions of tourist characteristics, levels of sexual experience, and demographic backgrounds. Results suggest tailoring sexual health promotion messages based on cluster affiliation, leveraging cluster-specific risk perceptions, motivations, and personal characteristics. This study provides recommendations for individually tailored, context-specific, age-appropriate, and gender-sensitive sexual health education programs.

Condom use negotiation among high school adolescents in Ghana: the role of gender

Gender has a profound effect on the sexual risk preventive intentions and behaviour of young people. However, little is known about the role of gender on condom use negotiation among adolescents in Ghana. This study explored gender differences in condom use negotiation among school-going adolescents in Ghana. Participants ( n = 684) completed self-report measures based on attitudes towards condom use, subjective norms regarding condom use, perceived behavioural control over condom use, intentions to use condoms, and on actual condom use behaviour. Results revealed statistically significant differences in condom use by gender. Specifically, attitudes towards condom use were more favourable among male students than they were among female students. Male students perceived slightly greater control over condom use than did female students. Moreover, male students reported slightly more condom-protected sexual behaviour than did female students. These results highlight the usefulness of designing gender-specific sexual risk reduction programmes among high school adolescents in Ghana.

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

The information–motivation–behavioral skills (IMB) model is useful for understanding sexual risk behavior, but has not been tested with hazardously-drinking sexually transmitted infection (STI) clinic patients, a subpopulation at greater HIV risk, or with a network-perspective sexual risk behavior outcome. Participants (N = 569) were STI clinic patients who screened positive for hazardous drinking and risky sexual behavior. Sexual risk behavior (SRB) was operationalized as a latent variable with three indicators: (1) number of sexual partners, (2) number of unprotected sex occasions with primary partner, and (3) number of unprotected sex occasions with non-primary partner(s). Preliminary analyses suggested SRB was best operationalized as a latent variable with two indicators, while unprotected sex with primary partners should be considered separately. In structural models with good fit, the IMB model was generally supported. The IMB model functioned differently for non-primary and multiple partners compared to primary partners in STI clinic patients with hazardous alcohol use.

Associations Among Neighborhood Characteristics and Sexual Risk Behavior Among Black and White MSM Living in a Major Urban Area

Identifying neighborhood characteristics associated with sexual HIV risk behavior among gay, bisexual and other men who have sex with men (MSM) living in urban areas may inform the development of policies and programs to reduce risk and subsequently HIV prevalence in urban areas. New York City M2M was a cross-sectional study designed to identify neighborhood-level characteristics associated with sexual risk behaviors among MSM living in New York City. This paper presents results of an analysis of neighborhood-level indicators of three distinct social theories of influence of the neighborhood environment on human behavior: physical disorder, social disorganization and social norms theories. Using multilevel modeling on a sample of 766 MSM stratified by race/ethnicity, we found little support for the role of social disorganization on the sexual risk behavior of MSM, whereas different indicators of physical disorder exerted negative effects across race groups. Our results suggest that the beneficial effects of housing stock maintenance and general neighborhood physical orderliness and cleanliness may have positive effects beyond those traditionally studied for African American MSM and that the field needs novel theorizing regarding whether and how neighborhood or virtual community-level factors relate to sexual behavior among MSM.

Predicting the Intention to Use Condoms and Actual Condom Use Behaviour: A Three-Wave Longitudinal Study in Ghana

BACKGROUND

Growing cross-sectional research shows that the theory of planned behaviour (TPB) is robust in predicting intentions to use condoms and condom use behaviour. Yet, little is known about the TPB's utility in explaining intentions to use condoms and condom use behaviour over time.

METHODS

This study used a longitudinal design and latent variable structural equation modelling to test the longitudinal relationships postulated by the TPB. School-going youths in Ghana provided data on attitudes, subjective norms, perceived control, intentions, and behaviour regarding condom use at three time points, spaced approximately three months apart.

RESULTS

As predicted by the TPB, the results showed that attitudes were significantly positively associated with intentions to use condoms over time. Contrary to the TPB, subjective norms were not significantly associated with intentions to use condoms over time. Perceived control did not predict intentions to use condoms over time. Moreover, intentions to use condoms were not significantly associated with self-reported condom use over time.

CONCLUSION

These results suggest that school-going youths in Ghana may benefit from sex education programmes that focus on within-subject attitude formation and activation. The theoretical and methodological implications of these results are discussed.

HIV-Risk Index: Development and Validation of a Brief Risk Index for Hispanic Young People

The prevalence of HIV risk behaviors among young people facilitates the spread of HIV, in particular regarding unsafe sex behavior, although this trend is different within this population. For this reason, identifying the riskier young population is required to prevent HIV infection. The main purpose of this study was to develop and validate a risk index to assess the different sexual HIV risk exposure among Hispanic Young people. For this purpose, 9861 Spanish young people were randomly distributed into two groups (derivation and validation group). According to the results, the factor analyses grouped the nine items of the HIV- risk index into two factors (factor 1, direct sexual risk indicators and factor 2, indirect sexual risk indicators) with an equal structure for men and women by a multi-group confirmatory factor analysis. The variance explained was 54.26 %. Moreover, the Cronbach's alpha coefficient revealed high internal reliability (α = .79) and the convergent validity supported its evidence based on different HIV risk indexes. Therefore, the HIV-risk index seem to be a rigorous and valid measure to estimate HIV risk exposure among young people.

A Randomized Controlled Trial to Increase HIV Preventive Information, Motivation, and Behavioral Skills in Ugandan Adolescents

BACKGROUND

One in 25 Ugandan adolescents is HIV positive.

PURPOSE

The aim of this study is to examine the impact of an Internet-based HIV prevention program on Information-Motivation-Behavioral skills (IMB) Model-related constructs.

METHODS

Three hundred and sixty-six sexually experienced and inexperienced students 13-18+years old in Mbarara, Uganda, were randomly assigned to the five-lesson CyberSenga program or the treatment-as-usual control group. Half of the intervention participants were further randomized to a booster session. Assessments were collected at 3 and 6 months post-baseline.

RESULTS

Participants' HIV-related information improved over time at a greater rate for the intervention groups compared to the control group. Motivation for condom use changed to a greater degree over time for the intervention group--especially those in the intervention+booster group--compared to the control group. Behavioral skills for condom use, and motivation and behavioral skills for abstinence were statistically similar over time for both groups.

CONCLUSIONS

CyberSenga improves HIV preventive information and motivation to use condoms.

Predicting condom use in adolescents: a test of three socio-cognitive models using a structural equation modeling approach

BACKGROUND

The theory of planned behavior (TPB), socio-cognitive model (SCM), and information-motivation-behavioral skills (IMB) model are effective in predicting condom use. However, the adequacy of these three theoretical models in predicting the frequency of condom use (FCU) among young people has not been compared. This cross-sectional study tested the applicability and suitability of these three models in predicting the FCU, and analyzed the relationships among the postulated constructs.

METHODS

Sexually experienced adolescents (n = 410) aged 13-18 completed a survey assessing the TPB, SCM, and IMB model constructs. Participants were students recruited from 18 high schools, randomly selected from the north, south, east, and southeast of Spain. A structural equation modelling (SEM) analysis was applied to test TPB, SCM and IBM and constructs relationships of each model using R.

RESULTS

The results of SEM demonstrated that behavioral skills predict behavior via motivation as hypothesized by the IMB model, but not directly via knowledge about condom use and sexually transmitted infections (STIs). Cognitive factors, such knowledge about condom use and STIs as well as condom use self-efficacy, directly predicted the FCU when modeled as per the SCM. According to the TPB, condom use intention was the best predictor of the FCU, and condom use intention was predicted by attitudes toward condom use and subjective norms related to condom use, but perceived control was not directly or indirectly related to the FCU. Based on the data, the TPB becomes the best-fit model for predicting the FCU among young people compared to the SCM and IMB model.

CONCLUSIONS

From a statistical perspective, the TPB seems to be the most suitable model for predicting the FCU among young people compared to the other models. Overall, key direct predictors of the FCU in adolescents included condom use intention, behavioral skills and cognitive factors, such as STIs knowledge and condom use self-efficacy. The next step should be to test integrative models that include personal, contextual, environmental, and social factors.

Neighborhood-level associations with HIV infection among young men who have sex with men in Chicago

The rising incidence of HIV infection among young men who have sex with men (YMSM) is a substantial public health concern. Traditional research on HIV among YMSM has focused largely on individual-level predictors and infrequently accounts for contextual or neighborhood-level factors such as ethnic composition and socioeconomic status. This study used neighborhood-level data from the US Census and other public sources, and individual-level data from a longitudinal cohort of YMSM in Chicago (Crew 450). Of the original 450 YMSM in the cohort, 376 reported living in Chicago (83.6 %) and were included in the analytic sample. A clustering approach was used to group the 77 community areas together by common characteristics, resulting in the identification of 11 distinct clusters. An unconditional model of individual HIV status indicated a significant amount of variance existed between neighborhood clusters (χ (2) = 21.66; p = 0.006). When individual-level variables were added to the model, only having an HIV-positive sex partner (OR = 6.41; CI 2.40, 17.1) and engaging in exchange sex in the past 6 months (OR = 3.25; 95 % CI 1.33, 7.93) were significant predictors of HIV status. Clusters with higher Walk Scores were less likely to contain HIV-positive individuals (OR = 0.94; 95 % CI 0.90, 0.98). Conversely, clusters with a larger proportion of vacant buildings were more likely to contain HIV-positive individuals (OR = 1.19; 95 % CI 1.07, 1.33). Future research among YMSM needs to investigate the mechanisms by which neighborhood of residence might influence engagement in risk behaviors or acquisition of HIV.

Individual, Interpersonal, and Structural Power: Associations With Condom Use in a Sample of Young Adult Latinos

Interviews were conducted with 480 sexually active Latino young adults from four rural counties in Oregon. We examined relationships between three levels of power (individual, interpersonal, and structural) and consistent condom use. Condom use self-efficacy and sexual decision-making, examples of individual and interpersonal measures of power, respectively, were associated with increased odds of consistent condom use among both men and women. Among men only, increasing relationship control, an interpersonal measure of power, was associated with lower odds of consistent condom use. Among women only, increasing medical mistrust, a structural measure of power, was associated with increased odds of consistent condom use.

Determinants of consistent condom use among college students in China: application of the information-motivation-behavior skills (IMB) model

Background

Due to the increase incidents of premarital sex and the lack of reproductive health services, college students are at high risk of HIV/AIDS infections in China. This study was designed to examine the predictors of consistency of condom use among college students based on the Information-Motivation-Behavioral Skills (IMB) model and to describe the relationships between the model constructs.

Methods

A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behavior among college students in five colleges and universities in Nanjing, China. An anonymous questionnaire survey was conducted for data collection, and the structural equation model (SEM) was used to assess the IMB model.

Results

A total of 3183 participants completed this study. The average age was 19.90 years (SD = 1.43, range 16 to 25). 342 (10.7%) participants of them reported having had premarital sex, among whom 30.7% reported having had a consistent condom use, 13.7% with the experience of abortion (including the participants whose sex partner has the same experience), 32.7% of participants had experience of multiple sex partners. The final IMB model provided acceptable fit to the data (CFI = 0.992, RMSEA = 0.028). Preventive behavior was significantly predicted by behavioral skills (β = 0.754, P<0.001). Information (β = 0.138, P<0.001) and motivation (β = 0.363, P<0.001) were indirectly affected preventive behavior, and was mediated through behavioral skills.

Conclusions

The results of the study demonstrate the utility of the IMB model for consistent condom use among college students in China. The main influencing factor of preventive behavior among college students is behavioral skills. Both information and motivation could affect preventive behavior through behavioral skills. Further research could develop preventive interventions based on the IMB model to promote consistent condom use among college students in China.

Predictors of consistent condom use based on the Information-Motivation-Behavior Skill (IMB) model among senior high school students in three coastal cities in China

BACKGROUND

High prevalence of risky sexual behaviors and lack of information, skills and preventive support mean that, adolescents face high risks of HIV/AIDS. This study applied the information-motivation-behavioral skills (IMB) model to examine the predictors of consistent condom use among senior high school students from three coastal cities in China and clarify the relationships between the model constructs.

METHODS

A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behaviors among senior high school students in three coastal cities in China. Structural equation modelling (SEM) was used to assess the IMB model.

RESULTS

Of the 12313 participants, 4.5% (95% CI: 4.2-5.0) reported having had premarital sex and among them 25.0% (95% CI: 21.2-29.1) reported having used a condom in their sexual debut. Only about one-ninth of participants reported consistent condom use. The final IMB model provided acceptable fit to the data (CFI = 0.981, RMSEA = 0.014). Consistent condom use was significantly predicted by motivation (β = 0.175, P < 0.01) and behavioral skills (β = 0.778, P < 0.01). Information indirectly predicted consistent condom use, and was mediated by behavioral skills (β = 0.269, P < 0.05).

CONCLUSIONS

The results highlight the importance of conducting HIV/AIDS preventive health promotion among senior high school students in China. The IMB model could predict consistent condom use and suggests that future interventions should focus on improving motivation and behavioral skills.

HIV information and behavioral skills moderate the effects of relationship type and substance use on HIV risk behaviors among African American youth

The HIV/AIDS epidemic is disproportionately impacting young African Americans. Efforts to understand and address risk factors for unprotected sex in this population are critical in improving prevention efforts. Situational risk factors, such as relationship type and substance use before sex, are in need of further study. This study explored how established cognitive predictors of risky sexual behavior moderated the association between situational factors and unprotected sex among low-income, African American adolescents. The largest main effect on the number of unprotected sex acts was classifying the relationship as serious (event rate ratio=10.18); other significant main effects were alcohol use before sex, participant age, behavioral skills, and level of motivation. HIV information moderated the effect of partner age difference, motivation moderated the effects of partner age difference and drug use before sex, and behavioral skills moderated the effects of alcohol and drug use before sex. This novel, partnership-level approach provides insight into the complex interactions of situational and cognitive factors in sexual risk taking.

Predictors of reducing sexual and reproductive risk behaviors based on the information-motivation-behavioral skills (IMB) model among unmarried rural-to-urban female migrants in Shanghai, China

Background

Due to the increase of premarital sex and the lack of reproductive health services, unmarried rural-to-urban female migrants experience more risks of sex and reproductive health (SRH). This study was designed to describe SRH related knowledge, attitude and risk behaviors among unmarried rural-to-urban female migrants and examine the predictors of reducing sexual and reproductive risk behaviors based on information-motivation-behavioral skills (IMB) model and to describe the relationships between the constructs.

Methods

We conducted a cross-sectional study to assess SRH related information, motivation, behavioral skills and preventive behaviors among unmarried rural-to-urban female migrants in Shanghai, one of the largest importers of migrant laborers in China. Structural equation modeling (SEM) was used to assess the IMB model.

Results

A total of 944 subjects completed their questionnaires. The mean age was 21.2 years old (SD = 2.3; range 16 to 28). Over one-fourth of participants reported having had premarital sex (N = 261, 27.6%) and among whom 15.3% reported having had the experience of unintended pregnancy, 14.6% with the experience of abortion. The final IMB model provided acceptable fit to the data (CFI = 0.99, RMSEA = 0.034). Reducing sexual and reproductive risk behaviors was significantly predicted by SRH related information (β = 0.681, P<0.001) and behavioral skills(β = 0.239, P<0.001). Motivation (β = 0.479, P<0.001) was the significant indirect predictor of reducing sexual and reproductive risk behaviors mediated through behavioral skills.

Conclusions

The results highlight the importance and necessity of conducting reproductive health promotion among unmarried rural-to-urban female migrants in China. The IMB model could be used to predict reducing sexual and reproductive risk behaviors and it suggests future interventions should focus on improving SRH related information and behavioral skills.

Examining the applicability of the IMB model in predicting condom use among sexually active secondary school students in Mbarara, Uganda

The applicability of the IMB model in predicting condom use was tested among 390 sexually active secondary school students in Mbarara, Uganda. Adolescents across five secondary schools completed a self-report survey about their health and sexual experiences. Based upon results from structural equation modeling, the IMB model partially predicts condom use. Condom use was directly predicted by HIV prevention information and behavioral skills regarding having and using condoms. It was indirectly predicted (through behavioral skills regarding having and using condoms) by behavioral intentions regarding using condoms and talking to one's partner about safer sex. Aspects of one's first sexual experience (i.e., age at first sex, having discussed using condoms with first sex partner, willingness at first sex) were strongly influential in predicting current condom use; this was especially true for discussing condoms with one's first sex partner. Findings highlight the importance of providing clear and comprehensive condom use training in HIV prevention programs aimed at Ugandan adolescents. They also underscore the importance of targeting abstinent youth before they become sexually active to positively affect their HIV preventive behavior at their first sexual experience.

Mediators of the relation between childhood sexual abuse and women's sexual risk behavior: a comparison of two theoretical frameworks

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood, but little research has investigated processes that might mediate this relation. The purpose of this study was to investigate whether constructs suggested by the traumagenic dynamics (TD) model (a theory of the effects of CSA) or constructs suggested by the information-motivation-behavioral skills (IMB) model (a theory of the antecedents of sexual risk behavior) better mediated the relation between CSA and sexual risk behavior in adulthood. Participants were 481 women attending a sexually transmitted infection clinic (66% African American) who completed a computerized survey as well as behavioral simulations assessing condom application and sexual assertiveness skills. Forty-five percent of the sample met criteria for CSA and CSA was associated with sexual risk behavior in adulthood. In multiple mediator models, the TD constructs mediated the relation between CSA and the number of sexual partners whereas the IMB constructs mediated the relation between CSA and unprotected sex. In addition, the TD constructs better mediated the relation between CSA and the number of sexual partners; the TD and IMB constructs did not differ in their ability to mediate the relation between CSA and unprotected sex. Sexual risk reduction interventions for women who were sexually abused should target not only the constructs from health behavior models (e.g., motivation and skills to reduce sexual risk), but also constructs that are specific to sexual abuse (e.g., traumatic sexualization and guilt).