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Using the COM‐B model to characterize the barriers and facilitators of pre‐exposure prophylaxis (PrEP) uptake in men who have sex with men
Author(s) -
Madhani Adam,
Finlay Katherine A.
Publication year - 2022
Publication title -
british journal of health psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.05
H-Index - 88
eISSN - 2044-8287
pISSN - 1359-107X
DOI - 10.1111/bjhp.12605
Subject(s) - men who have sex with men , pre exposure prophylaxis , thematic analysis , psychology , intervention (counseling) , focus group , sexual orientation , social psychology , homosexuality , sexual minority , qualitative research , clinical psychology , medicine , family medicine , human immunodeficiency virus (hiv) , psychiatry , social science , syphilis , marketing , sociology , business , psychoanalysis
Objectives 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). Design and Method 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 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. Conclusion 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.