Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities—HPTN 073
Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client’s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivat...
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| Veröffentlicht in: | Journal of Urban Health Jg. 99; H. 6; S. 1157 - 1169 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
New York
Springer Science and Business Media LLC
01.12.2022
Springer US Springer Nature B.V |
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| ISSN: | 1099-3460, 1468-2869, 1468-2869 |
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| Abstract | Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client’s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (
N
= 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (
χ
2
= 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (
χ
2
= 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. |
|---|---|
| AbstractList | Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ
= 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ
= 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client’s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. Abstract Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client’s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men.Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client’s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US ( N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum ( χ 2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse ( χ 2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. |
| Author | Donte T. Boyd Lisa Hightow-Weidman Sheldon D. Fields S. Raquel Ramos Kenneth H. Mayer Leo Wilton Steve Shoptaw Geetha Beauchamp Wale Ajiboye Estelle Piwowar-Manning Portia Thomas Donaldson F. Conserve Darrell P. Wheeler Lynda Emel Mandy J. Hill Manya Magnus Darren Whitfield LaRon E. Nelson |
| Author_xml | – sequence: 1 givenname: LaRon E. orcidid: 0000-0002-2630-602X surname: Nelson fullname: Nelson, LaRon E. email: laron.nelson@yale.edu organization: School of Nursing, Yale University, Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto – sequence: 2 givenname: Donte T. surname: Boyd fullname: Boyd, Donte T. organization: Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, College of Social Work, The Ohio State University – sequence: 3 givenname: Geetha surname: Beauchamp fullname: Beauchamp, Geetha organization: Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center – sequence: 4 givenname: Lynda surname: Emel fullname: Emel, Lynda organization: Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center – sequence: 5 givenname: Leo surname: Wilton fullname: Wilton, Leo organization: Department of Human Development, College of Community and Public Affairs, State University of New York at Binghamton, Department of Humanities, University of Johannesburg – sequence: 6 givenname: Darren surname: Whitfield fullname: Whitfield, Darren organization: School of Social Work, University of Maryland Baltimore – sequence: 7 givenname: S. Raquel surname: Ramos fullname: Ramos, S. Raquel organization: School of Nursing, Yale University, Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University – sequence: 8 givenname: Wale surname: Ajiboye fullname: Ajiboye, Wale organization: MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto – sequence: 9 givenname: Mandy J. surname: Hill fullname: Hill, Mandy J. organization: Department of Emergency Medicine, McGovern Medical School, University of Texas Health – sequence: 10 givenname: Donaldson F. surname: Conserve fullname: Conserve, Donaldson F. organization: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Universty – sequence: 11 givenname: Portia surname: Thomas fullname: Thomas, Portia organization: Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, Department of Medicine, State University of New York Downstate Medical Center – sequence: 12 givenname: Lisa surname: Hightow-Weidman fullname: Hightow-Weidman, Lisa organization: Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill – sequence: 13 givenname: Steve surname: Shoptaw fullname: Shoptaw, Steve organization: Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles – sequence: 14 givenname: Manya surname: Magnus fullname: Magnus, Manya organization: Department of Epidemiology, Milken Institute School of Public Health, George Washington University – sequence: 15 givenname: Kenneth H. surname: Mayer fullname: Mayer, Kenneth H. organization: The Fenway Institute, Fenway Health – sequence: 16 givenname: Estelle surname: Piwowar-Manning fullname: Piwowar-Manning, Estelle organization: Department of Pathology, School of Medicine, Johns Hopkins University – sequence: 17 givenname: Sheldon D. surname: Fields fullname: Fields, Sheldon D. organization: Ross and Carol Nese College of Nursing, Pennsylvania State University – sequence: 18 givenname: Darrell P. surname: Wheeler fullname: Wheeler, Darrell P. organization: Iona College |
| BackLink | https://cir.nii.ac.jp/crid/1870865117597822720$$DView record in CiNii https://www.ncbi.nlm.nih.gov/pubmed/35939181$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1186_s13722_024_00520_3 crossref_primary_10_1007_s40615_024_02225_4 crossref_primary_10_2196_67445 crossref_primary_10_1038_s41598_024_63123_7 |
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| Copyright | The New York Academy of Medicine 2022 2022. The New York Academy of Medicine. The New York Academy of Medicine 2022. |
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| Issue | 6 |
| Keywords | Path analysis HPTN Black MSM Structural equation modeling Condom use HIV prevention Multi-level intervention PrEP Multicomponent intervention Self-determination theory HIV HIV Prevention Trials Network Sexually transmitted infection Disparities Autonomy support |
| Language | English |
| License | 2022. The New York Academy of Medicine. |
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| PublicationTitle | Journal of Urban Health |
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| SubjectTerms | 3.1 Primary prevention interventions to modify behaviours or promote wellbeing Anal intercourse and promotion of well-being Antiretroviral drugs Autonomy Autonomy support Behavior Behavioral and Social Science Black MSM Black people Cities Clinical Research Coercion Competence Disease prevention Disparities Enactment Epidemiology Good Health and Well Being Health behavior Health care Health care industry Health Disparities Health Informatics Health Sciences Health services HIV HIV Infections HIV Infections - prevention & control HIV prevention HIV Prevention Trials Network HIV/AIDS Homosexuality Homosexuality, Male HPTN HPTN 073 Study Team Human immunodeficiency virus Human Movement and Sports Sciences Humans Infectious Diseases Male Medicine Medicine & Public Health Men who have sex with men Mental Health Motivation Multi-level intervention Multicomponent intervention Path analysis Pre-Exposure Prophylaxis PrEP Prevention Prevention of disease and conditions Prevention programs Prophylaxis Psychological needs Public Health Public Health and Health Services Regulation Satisfaction Scientific evidence Self control Self determination Self regulation Self-determination theory Serum Sexual and Gender Minorities Sexual and Gender Minorities (SGM/LGBT) Sexual intercourse Sexually transmitted diseases Sexually transmitted infection Sexually Transmitted Infections STD Structural equation modeling Structural equation modeling Condom use Therapy |
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| Title | Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities—HPTN 073 |
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