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      Condom Use and Related Factors among Rural and Urban Men Who Have Sex With Men in Western China: Based on Information-Motivation-Behavioral Skills Model

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          Abstract

          This study aimed to determine the differences in condom use and related factors among rural–urban men who have sex with men (MSM) in Western China. A cross-sectional survey was conducted in Chongqing, Sichuan, and Guangxi, which recruited MSM by non-probability sampling. Data were collected through an anonymous, standardized, and self-reported questionnaire guided by an information–motivation–behavioral skills model. Structural equation model was applied to analyze the related factors. Out of the 1141 MSM included in this analysis, 856 (75%) and 285 (25%) were from urban and rural areas, respectively. The median age was 27 years for both groups. Self-reported consistent condom use for anal sex in the past 6 months was 57.58%. The rate of consistent condom use was lower in rural MSM than in urban MSM (50.88% vs. 59.81%, p = .008). Behavioral skills, HIV/AIDS intervention services, and response costs had direct positive and negative influences on condom use, respectively. By contrast, motivation and information exhibited indirect influence. All the factors were mediated by behavioral skills in rural and urban MSM, except for the information that had no effect among urban MSM but had an indirect effect among rural MSM. These findings suggest that service providers should pay attention to substantial rural–urban differences and design different AIDS prevention and intervention strategies targeting rural and urban MSM.

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          Most cited references34

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          Development and psychometric evaluation of the brief HIV Knowledge Questionnaire.

          This research evaluated the psychometric properties of a brief self-report measure of HIV-related knowledge, the 18-item HIV Knowledge Questionnaire (HIV-KQ-18). Low-income men and women (N = 1,019) responded to 27 items that represented the domain of interest. Item analyses indicated that 18 items, with item-total correlations ranging from .24 to .57, be retained. Additional analyses demonstrated the HIV-KQ-18's internal consistency across samples (alphas = .75-.89), test-retest stability across several intervals (rs = .76- .94), and strong associations with a much longer, previously validated measure (rs = .93-.97). Data from three clinical trials indicated that the HIV-KQ-18 detected knowledge gains in treated participants when compared to untreated controls. We conclude that the HIV-KQ-18 is internally consistent, stable, sensitive to the change resulting from intervention, and suitable for use with low-literacy populations.
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            Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university students.

            This article contains empirical tests of the information-motivation-behavioral skills (IMB) model of AIDS-preventive behavior (J.D. Fisher & Fisher, 1992; W.A. Fisher & Fisher, 1993a), which has been designed to understand and predict the practice of AIDS-preventive acts. The IMB model holds that AIDS-preventive behavior is a function of individuals' information about AIDS prevention, motivation to engage in AIDS prevention, and behavioral skills for performing the specific acts involved in prevention. The model further assumes that AIDS-prevention information and motivation generally work through AIDS-prevention behavioral skills to influence the initiation and maintenance of AIDS-preventive behavior. Supportive tests of the model, using structural equation modeling techniques, are reported with populations of gay male affinity group members (n = 91) and heterosexual university students (n = 174).
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              Development and validation of a condom self-efficacy scale for college students.

              This study proposed to develop and validate a scale for the college population that measures self-efficacy in using condoms. The Condom Use Self-Efficacy Scale (CUSES) was derived from several sources and consisted of 28 items describing an individual's feelings of confidence about being able to purchase condoms, put them on and take them off, and negotiate their use with a new sexual partner. This scale was administered to a sample of 768 college students. It was found to possess adequate reliability (Cronbach's alpha = .91; test-retest correlation = .81) and correlated well with the Attitude Toward the Condom Scale (r = .51) and the Contraceptive Self-Efficacy Scale for women (r = .55). Our scale also correlated with a measure of intention to use condoms (r = .40) but was unrelated to a measure of social desirability. Students who differed on measures of previous condom use as well as on sexual intercourse experience also showed significant differences on this scale in the expected direction, indicating evidence of this scale's discriminant validity. The potential uses of this scale in a college population are discussed, along with the issues underlying condom usage self-efficacy.
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                Author and article information

                Journal
                Am J Mens Health
                Am J Mens Health
                JMH
                spjmh
                American Journal of Men's Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1557-9883
                1557-9891
                6 February 2020
                Jan-Feb 2020
                : 14
                : 1
                : 1557988319899799
                Affiliations
                [1 ]Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
                [2 ]Clinical Epidemiology and Biostatistics Department, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
                [3 ]Chongqing Center for Disease Control and Prevention, Chongqing, China
                [4 ]Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS, USA
                [5 ]School of Health Sciences, Walden University, Minneapolis, MN, USA
                [6 ]The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
                Author notes
                [*]Mengliang Ye, Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China. Email: yemengliang@ 123456cqmu.edu.cn
                [†]

                These authors contributed equally to this work and should be regarded as co-first authors.

                Author information
                https://orcid.org/0000-0001-9394-8682
                Article
                10.1177_1557988319899799
                10.1177/1557988319899799
                7008563
                32028826
                ed2455d7-e124-4b7a-8d1b-67a57b20ebca
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 14 August 2019
                : 11 November 2019
                : 17 December 2019
                Categories
                HIV/AIDS/STIs
                Original Article
                Custom metadata
                January-February 2020
                ts1

                men who have sex with men (msm),condom use,information–motivation–behavioral skills model (imb),structural equation model (sem),sexual behaviors,hiv/aids prevention

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