Using the theory of planned behaviour and self-identity to explain chlamydia testing intentions in young people living in deprived areas

Physical activity behavior during Covid 19 pandemic among Iranian dwellers in Southern Iran based on planned behavior theory: a SEM analysis

BACKGROUND

The COVID-19 pandemic restrictions curtailed physical activity. The current study applied an integrated Theory of Planned Behavior to identify the determinants of physical activity behavior and the processes involved in the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted in Shiraz city, Southern Iran, among 2500 people who met the inclusion criteria were included in the study. Data were collected using the demographic information questions and questionnaire based on the Theory of Planned Behavior (TPB) constructs. The Questionnaire via WhatsApp, emails, and SMS was shared. Data analysis was performed using SPSS26 and Amos version 24. Mean and standard deviation was used to describe the data. Also, one-way ANOVA and structural equation analysis were used to analyze the data. The significance level in all the tests was considered to be 0.05.

RESULTS

One thousand one hundred sixty-nine samples (46.8%) said they had been exercising less than 3 days a week, and 47.6% of them did not have any exercise or physical activities (n = 1191). The mean score of attitudes, SN, PBC, and intention were 9.38 ± 2.07, 9.27 ± 2.03, 9.32 ± 2.05, and 12.29 ± 2.35, respectively. The effect size values demonstrate the independent variables' high coefficient of influence on explaining the theoretical model. According to the results, the factors play an important role in samples' intention (η² ≥ 0.2, p ≤ 0.05). The effect size of intention on doing physical activities and exercise during the SARS-CoV-2 pandemic is Eta square = 0.777, which means the measure was high. The obtained model was good based on the main goodness of fit indices (Chi2 = 108.6, df = 25, n = 2500, Chi2/df = 4.344, RMSEA = 0.036, AGFI = 0.92, CFI = 0.95, GFI = 0.90, Fornell-Larcker criterion = 0.87, HTMT = 0.89).

CONCLUSION

The TPB provides a useful framework to explore psychosocial determinants of physical activity behavior during the pandemic and identify key strategies for program planning aimed at improving exercise among people who were already influenced by quarantine and lockdown restrictions.

The operationalization of self-identity in reasoned action models: a systematic review of self-identity operationalizations in three decades of research

Background

Self-identity has frequently been proposed as a useful addition to the Theory of Planned Behavior; yet Fishbein and Ajzen decided to not include self-identity when they published that theory's successor, the Reasoned Action Approach. One of their reasons for exclusion is the lack of clear conceptual independence, as manifested in self-identity operationalizations that often conflate the construct with attitudinal or normative measures. Therefore, establishing whether self-identity has added value in the Reasoned Action Approach first requires synthesis of the used operationalisations to develop an operationalization that captures self-identity but not attitude and perceived norm.

Method

In this systematic review we identified 153 articles through the PsycINFO database and descendency approach using Google Scholar. In total, 342 of the operationalisations of self-identity were identified in studies operationalizing it as a potential Reasoned Action Approach extension.

Results and conclusions

After analyzing the full item pool to eliminate duplicates and items that did not measure selfidentity, (also) measured attitudes or norms, did not allow tailoring formulations to target, action, context and time, were not applicable to a wide variety of behaviors, or were ambiguous, seven prototypical items remained. These items lend themselves well for further psychometric study to establish the conceptual independence of self-identity from other Reasoned Action Approach constructs such as attitude and perceived norms.

Hypotheses for the Reasons behind Beer Consumer's Willingness to Purchase Beer: An Expanded Theory from a Planned Behavior Perspective

Because beer is one of the most common alcoholic beverages consumed in the world, this research adopted an expanded theory of planned behavior (TPB) perspective to understand why beer consumers purchase beer. This study investigated the effects of injunctive norms, descriptive norms, attitude, and perceived behavioral control on alcohol identity and purchase intention. The possible mediating role of alcohol identity was also investigated. This study was conducted in Taiwan, and a total of 452 beer consumers participated in the survey. Structural equation modeling was used to examine the relationship among the study variables. The results revealed that alcohol identity positively influences purchase intention, and attitude positively affects alcohol identity and purchase intention. In addition, injunctive norms have a positive influence on alcohol identity, and descriptive norms positively affect purchase intention. In particular, perceived behavioral control has a negative influence on alcohol identity but has a positive influence on purchase intention. This study also found that alcohol identity mediates the attitude–purchase intention relationship. By examining the consumption behavior of beer consumers from the TPB perspective, this study contributed to an understanding of beer consumption behavior.

Exploring psychosocial predictors of STI testing in University students

Background

To explore university students’ Sexually Transmitted Infection (STI) testing knowledge, psychosocial and demographic predictors of past STI testing behaviour, intentions to have an STI test, and high risk sexual behaviour, to inform interventions promoting STI testing in this population.

Methods

A cross-sectional, quantitative online survey was conducted in March 2016, recruiting university students from North East Scotland via an all-student email. The anonymous questionnaire assessed student demographics (e.g. sex, ethnicity, age), STI testing behaviours, sexual risk behaviours, knowledge and five psychological constructs thought to be predictive of STI testing from theory and past research: attitudes, perceived susceptibility to STIs, social norms, social fear and self-efficacy.

Results

The sample contained 1294 sexually active students (response rate 10%) aged 18–63, mean age = 23.61 (SD 6.39), 888 (69%) were female. Amongst participants, knowledge of STIs and testing was relatively high, and students held generally favourable attitudes. 52% reported ever having an STI test, 13% intended to have one in the next month; 16% reported unprotected sex with more than one ‘casual’ partner in the last six months. Being female, older, a postgraduate, longer UK residence, STI knowledge, perceived susceptibility, subjective norms, attitudes and self-efficacy all positively predicted past STI testing behaviour (p < 0.01). Perceived susceptibility to STIs and social norms positively predicted intentions to have an STI test in the next month (p  < 0.05); perceived susceptibility also predicted past high-risk sexual behaviour (p < 0.01).

Conclusions

Several psychosocial predictors of past STI testing, of high-risk sexual behaviour and future STI intentions were identified. Health promotion STI testing interventions could focus on male students and target knowledge, attitude change, and increasing perceived susceptibility to STIs, social norms and self-efficacy towards STI-testing.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5587-2) contains supplementary material, which is available to authorized users.

Self-Reported Impact of Chlamydia Testing on Subsequent Behavior: Results of an Online Survey of Young Adults in England

BACKGROUND

The National Chlamydia Screening Programme performs 1.7 million tests annually among young adults in England. The effect of chlamydia screening on subsequent behavior is unknown. This study examined the self-reported impact of testing on young adults' subsequent health care-seeking and sexual behavior.

METHODS

We conducted a cross-sectional Web-based anonymous survey using an online panel to recruit 1521 young adults aged 16 to 24 years and resident in England. Survey questions were developed using the theory of planned behavior. Multivariate log-binomial regression was used to identify the variables associated with an impact on subsequent behavior after testing.

RESULTS

Most respondents reported that being tested for chlamydia had a positive effect on their subsequent sexual behavior (68.6%; 422/615) or health care-seeking behavior (80.0%; 492/615). In multivariate analysis, being female and having a high level of engagement at last test were both associated with positive impacts on sexual behavior (72.7% [adjusted prevalence ratio {aPR}, 1.19; 95% confidence interval {CI}, 1.07-1.33] and 82.7% [aPR, 1.55; 95% CI, 1.27-1.89], respectively), and health care-seeking behavior (84.4% [aPR, 1.13; 95% Cl, 1.04-1.24] and 86.3% [aPR, 1.23; 95% CI, 1.07-1.41], respectively). Among respondents with minimum level of engagement, 72.4% (76/105) reported an increase in subsequent health care-seeking behavior.

CONCLUSIONS

Chlamydia testing had a positive impact on young adults' self-reported health care-seeking and sexual behavior. This suggests that chlamydia screening has a wider effect on young adults' sexual health beyond that of treatment alone.

Predictors of Chlamydia Trachomatis testing: perceived norms, susceptibility, changes in partner status, and underestimation of own risk

Background

It is hard to convince people to participate in chlamydia screening programs outside the clinical setting. In two earlier studies (BMC Public Health. 2013;13:1091; J Med Internet Res. 2014;16(1):e24), we identified explicit and implicit determinants of chlamydia screening behavior and attempted, unsuccessfully, to improve participation rates by optimizing the recruitment letter. In the present study, we examined the links between a number of social-cognitive determinants (e.g., stereotypical beliefs about a person with chlamydia, intentions, changes in partner status), and self-reported chlamydia testing behavior six months after the initial study.

Methods

The present study is a follow-up to our first study (T0). We assessed self-reported testing behavior 6 months after the first measure by means of an online questionnaire (T1; N = 269). Furthermore, at T1, we measured the social-cognitive determinants in more detail, and explored the influence of stereotypical beliefs and any changes in partner status during this six month period.

Results

In total, 25 (9.1 %) of the participants tested for chlamydia at some point during the six months between baseline (T0) and follow up (T1). Testing behavior was influenced by testing intentions in combination with changes in risk behavior. The higher the participants’ own numbers of partners ever, the higher they estimated the number of partners of the stereotypical person with chlamydia. Testing intentions were most strongly predicted by perceived norms and susceptibility, and having had multiple partners in the last 6 months (R² = .41).

Conclusion

The most relevant determinants for testing intentions and behavior were susceptibility, subjective norms and changes in partner status. We found a systematic tendency for individuals to underestimate their own risk, especially the risk of inconsistent condom use. Future research should focus on more promising alternatives to population-based interventions, such as online interventions, screening in primary care, the rescreening of positives, and clinic-based interventions. This future research should also focus on making testing easier and reducing barriers to testing, as well as using social and sexual networks in order to reach more people.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2689-6) contains supplementary material, which is available to authorized users.

An online study combining the constructs from the theory of planned behaviour and protection motivation theory in predicting intention to test for chlamydia in two testing contexts

Chlamydia is a common sexually transmitted infection that has potentially serious consequences unless detected and treated early. The health service in the UK offers clinic-based testing for chlamydia but uptake is low. Identifying the predictors of testing behaviours may inform interventions to increase uptake. Self-tests for chlamydia may facilitate testing and treatment in people who avoid clinic-based testing. Self-testing and being tested by a health care professional (HCP) involve two contrasting contexts that may influence testing behaviour. However, little is known about how predictors of behaviour differ as a function of context. In this study, theoretical models of behaviour were used to assess factors that may predict intention to test in two different contexts: self-testing and being tested by a HCP. Individuals searching for or reading about chlamydia testing online were recruited using Google Adwords. Participants completed an online questionnaire that addressed previous testing behaviour and measured constructs of the Theory of Planned Behaviour and Protection Motivation Theory, which propose a total of eight possible predictors of intention. The questionnaire was completed by 310 participants. Sufficient data for multiple regression were provided by 102 and 118 respondents for self-testing and testing by a HCP respectively. Intention to self-test was predicted by vulnerability and self-efficacy, with a trend-level effect for response efficacy. Intention to be tested by a HCP was predicted by vulnerability, attitude and subjective norm. Thus, intentions to carry out two testing behaviours with very similar goals can have different predictors depending on test context. We conclude that interventions to increase self-testing should be based on evidence specifically related to test context.

The influence of two different invitation letters on Chlamydia testing participation: randomized controlled trial

Background

In the Netherlands, screening for chlamydia (the most prevalent sexually transmitted infection worldwide) is a relatively simple and free procedure. Via an invitation letter sent by the public health services (PHS), people are asked to visit a website to request a test kit. They can then do a chlamydia test at home, send it anonymously to a laboratory, and, within two weeks, they can review their test results online and be treated by their general practitioner or the PHS. Unfortunately, the participation rates are low and the process is believed to be not (cost-) effective.

Objective

The objective of this study was to assess whether the low participation rate of screening for chlamydia at home, via an invitation letter asking to visit a website and request a test kit, could be improved by optimizing the invitation letter through systematically applied behavior change theories and evidence.

Methods

The original letter and a revised letter were randomly sent out to 13,551 citizens, 16 to 29 years old, in a Dutch municipality. Using behavior change theories, the revised letter sought to increase motivation to conduct chlamydia screening tests. The revised letter was tailored to beliefs that were found in earlier studies: risk perception, advantages and disadvantages (attitude), moral norm, social influence, and response- and self-efficacy. Revisions to the new letter also sought to avoid possible unwanted resistance caused when people feel pressured, and included prompts to trigger the desired behavior.

Results

No significant differences in test package requests were found between the two letters. There were also no differences between the original and revised letters in the rates of returned tests (11.80%, 581/4922 vs 11.07%, 549/4961) or positive test results (4.8%, 23/484 vs 4.1%, 19/460). It is evident that the new letter did not improve participation compared to the original letter.

Conclusions

It is clear that the approach of inviting the target population through a letter does not lead to higher participation rates for chlamydia screening. Other approaches have to be developed and pilot tested.

Using the Theory of Planned Behavior to identify key beliefs underlying chlamydia testing intentions in a sample of young people living in deprived areas

The Theory of Planned Behavior was used to identify the key behavioural, normative and control beliefs underlying intentions to test regularly for chlamydia among young people living in socially and economically deprived areas – a high-risk group for infection. Participants ( N = 278, 53% male; mean age 17 years) were recruited from a vocational college situated in an area in the most deprived national quintile (England). Participants completed measures of behavioural, normative and control beliefs, plus intention to test regularly for chlamydia. The behavioural, normative and control beliefs most strongly correlated with intentions to test regularly for chlamydia were beliefs about stopping the spread of infection, partners’ behaviour and the availability of testing. These beliefs represent potential targets for interventions to increase chlamydia testing among young people living in deprived areas.