School of Psychology, University of Buckingham, Buckingham, UK.
School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Br J Health Psychol. 2022 Nov;27(4):1330-1353. doi: 10.1111/bjhp.12605. Epub 2022 Jun 13.
Using the COM-B model, this study aimed to characterize barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake amongst men who have sex with men (MSM).
Semistructured interviews with 13 MSM who were non-PrEP users were conducted with a specific focus on barriers and facilitators to PrEP uptake. A 15-item interview schedule was created informed by the COM-B model. Transcripts were transcribed verbatim and inductively analysed using thematic analysis. To illustrate pathways for intervention design, inductive themes were then deductively mapped onto COM-B constructs.
Results demonstrated that barriers to PrEP uptake were closely aligned with five (of six) COM-B components: psychological capability, physical opportunity, social opportunity, reflective motivation and automatic motivation. These COM-B subcomponents reflected seven thematized barriers: (1) limited information about PrEP, (2) restricted access to PrEP, (3) gay identity and sexual stigmatization, (4) social and cultural stigmatization, (5) capabilities in treatment adherence, (6) optimistic bias about sexual behaviours and (7) calculating risk. No facilitators or physical capability concerns were demonstrated.
This study adopted a novel behaviour change-informed approach to understanding barriers and facilitators to PrEP uptake amongst MSM. Unrealistic optimism about self-protective individual behaviours, the physical accessibility of PrEP and (mis)information together interacted closely with perceptions of personal and social stigmatization to dynamically impact PrEP uptake decisions. Barriers to PrEP uptake mapped clearly to the COM-B; therefore, these results provide the foundation for Behaviour Change Wheel intervention development to improve rates of PrEP uptake and its acceptability for MSM.
本研究运用 COM-B 模型，旨在描述男男性行为者（MSM）人群中预防用暴露前药物（PrEP）的使用障碍和促进因素。
对 13 名未使用 PrEP 的 MSM 进行半结构式访谈，重点关注 PrEP 使用的障碍和促进因素。根据 COM-B 模型创建了一份包含 15 个项目的访谈提纲。对转录本进行逐字转录，并使用主题分析进行归纳分析。为了说明干预设计的途径，归纳主题随后被演绎映射到 COM-B 结构上。
研究结果表明，PrEP 使用障碍与 COM-B 的五个（六个中的六个）组成部分密切相关：心理能力、物理机会、社会机会、反思动机和自动动机。这些 COM-B 子组成部分反映了七个主题化的障碍：（1）对 PrEP 的信息有限，（2）获取 PrEP 的限制，（3）同性恋身份和性污名化，（4）社会和文化污名化，（5）治疗依从性的能力，（6）对性行为的乐观偏见，以及（7）风险计算。没有发现促进因素或物理能力的担忧。
本研究采用了一种新颖的基于行为改变的方法来理解 MSM 中 PrEP 使用的障碍和促进因素。对自我保护个人行为的不切实际的乐观、PrEP 的物理可及性以及（错误）信息与对个人和社会污名化的感知密切互动，对 PrEP 使用决策产生了动态影响。PrEP 使用障碍与 COM-B 明确相关；因此，这些结果为行为改变轮干预的发展提供了基础，以提高 MSM 中 PrEP 的使用率和可接受性。
