Social norms, gender, and power related to PrEP use among Black women in Washington, DC: A Bayesian approach
Summary:
Preexposure prophylaxis (PrEP) is an effective method of preventing Human Immunodeficiency Virus (HIV) and is indicated for men and women who practice injection drug use or sexual risk behaviors. However, PrEP use among women in the US remains disproportionately low compared to men, and Black and Latino women have lower rates of PrEP use compared to White women, despite having higher HIV diagnosis rates. Nuanced sociocultural factors may also underlie low rates of PrEP uptake, and there exists a major research gap related to gender, power, and social norms as they affect PrEP use in this population. It is also unclear what approaches to the communication of PrEP information may be most effective for increasing rates of PrEP use. The present study integrates the Theory of Gender and Power with the Theory of Normative Social Behavior to determine the effectiveness of an intervention to improve behavioral intention to use PrEP among adult Black women attending a clinic in Washington, DC. The intervention involved three conditions: a gain-framed, loss-framed, and control condition. A Bayesian approach was utilized to determine the effect of three different PrEP advertisements on intentions to use PrEP. This approach leverages powerful Markov Chain Monte Carlo algorithms to estimate the posterior distribution of each theory-driven variable to determine their relationship with PrEP use intentions. This study sheds light on the disparities in PrEP use in this marginalized population and provides evidence-based recommendations for improved PrEP marketing and communications in order to bridge the gap.
Background/Objectives:
The present study proposes using the Theory of Normative Social Behavior and Theory of Gender and Power to determine 1) which treatment condition (gain-frame, loss-frame, and neutral) results in greater expressed intention to use PrEP; 2) how Gendered Division of Labor and Gendered Division of Power relate to intention to use PrEP; and 3) how perceived injunctive and descriptive norms relate to intention to use PrEP.
Description of Intervention and/or Methods/Design:
Consenting Black women attending a clinic in Washington, DC were randomly assigned to view a PrEP advertisement that was either gain-framed, loss-framed, or neutral, and respond to a survey. The Bayesian equivalent of an ANOVA will be performed to determine the posterior distribution of PrEP intention for each treatment condition. Posterior probabilities will be obtained for all possible treatment group comparisons. This will provide an estimate of the effectiveness of each treatment condition on PrEP intention. To determine the effect of each construct on the outcome, a Bayesian linear regression will be performed to obtain the probability distribution of each model parameter, incorporating informative priors specified as a result of previous research. MCMC algorithms will be used in the estimation process, and Bayesian 95% Highest Density Intervals will be used to confirm or falsify a priori hypotheses.
Results/Lessons Learned:
The analyses will provide an understanding of the effectiveness of different communication strategies to improve PrEP use. The overall treatment effect will provide an indication of whether gain-framed, loss-framed, or neutral messages are more effective in increasing PrEP use intention. The more detailed Bayesian regression analyses will shed light on the complex interplay of theory-driven factors which affect PrEP use among this marginalized population. In particular, the influence of perceived social norms (both injunctive and descriptive) on PrEP use intention will be determined, while accounting for nuanced multidimensional factors related to the context in which these women live. These results will be useful not only for future rigorous, theory-driven research in the domain of PrEP use among racial and ethnic minorities, but will also offer concrete factors to target for future programs and policies to reduce health disparities.
Discussion/Implications for the Field:
The field of health communication and SBCC in general requires both conceptual and methodological rigor in order to accurately evaluate the effects of complex interventions. This study will offer an integrated a theory-driven framework to conduct SBCC work in PrEP use studies, as well as a rigorous empirical approach. The use of Bayesian methods in particular has not been widely used in the field of HIV Prevention/PrEP use, and is usefully applied in this context to determine the influence of theoretical constructs on the outcome. In particular, the promise of MCMC algorithms to this field is illustrated.
Abstract submitted by:
Shaon Lahiri - George Washington University
Preexposure prophylaxis (PrEP) is an effective method of preventing Human Immunodeficiency Virus (HIV) and is indicated for men and women who practice injection drug use or sexual risk behaviors. However, PrEP use among women in the US remains disproportionately low compared to men, and Black and Latino women have lower rates of PrEP use compared to White women, despite having higher HIV diagnosis rates. Nuanced sociocultural factors may also underlie low rates of PrEP uptake, and there exists a major research gap related to gender, power, and social norms as they affect PrEP use in this population. It is also unclear what approaches to the communication of PrEP information may be most effective for increasing rates of PrEP use. The present study integrates the Theory of Gender and Power with the Theory of Normative Social Behavior to determine the effectiveness of an intervention to improve behavioral intention to use PrEP among adult Black women attending a clinic in Washington, DC. The intervention involved three conditions: a gain-framed, loss-framed, and control condition. A Bayesian approach was utilized to determine the effect of three different PrEP advertisements on intentions to use PrEP. This approach leverages powerful Markov Chain Monte Carlo algorithms to estimate the posterior distribution of each theory-driven variable to determine their relationship with PrEP use intentions. This study sheds light on the disparities in PrEP use in this marginalized population and provides evidence-based recommendations for improved PrEP marketing and communications in order to bridge the gap.
Background/Objectives:
The present study proposes using the Theory of Normative Social Behavior and Theory of Gender and Power to determine 1) which treatment condition (gain-frame, loss-frame, and neutral) results in greater expressed intention to use PrEP; 2) how Gendered Division of Labor and Gendered Division of Power relate to intention to use PrEP; and 3) how perceived injunctive and descriptive norms relate to intention to use PrEP.
Description of Intervention and/or Methods/Design:
Consenting Black women attending a clinic in Washington, DC were randomly assigned to view a PrEP advertisement that was either gain-framed, loss-framed, or neutral, and respond to a survey. The Bayesian equivalent of an ANOVA will be performed to determine the posterior distribution of PrEP intention for each treatment condition. Posterior probabilities will be obtained for all possible treatment group comparisons. This will provide an estimate of the effectiveness of each treatment condition on PrEP intention. To determine the effect of each construct on the outcome, a Bayesian linear regression will be performed to obtain the probability distribution of each model parameter, incorporating informative priors specified as a result of previous research. MCMC algorithms will be used in the estimation process, and Bayesian 95% Highest Density Intervals will be used to confirm or falsify a priori hypotheses.
Results/Lessons Learned:
The analyses will provide an understanding of the effectiveness of different communication strategies to improve PrEP use. The overall treatment effect will provide an indication of whether gain-framed, loss-framed, or neutral messages are more effective in increasing PrEP use intention. The more detailed Bayesian regression analyses will shed light on the complex interplay of theory-driven factors which affect PrEP use among this marginalized population. In particular, the influence of perceived social norms (both injunctive and descriptive) on PrEP use intention will be determined, while accounting for nuanced multidimensional factors related to the context in which these women live. These results will be useful not only for future rigorous, theory-driven research in the domain of PrEP use among racial and ethnic minorities, but will also offer concrete factors to target for future programs and policies to reduce health disparities.
Discussion/Implications for the Field:
The field of health communication and SBCC in general requires both conceptual and methodological rigor in order to accurately evaluate the effects of complex interventions. This study will offer an integrated a theory-driven framework to conduct SBCC work in PrEP use studies, as well as a rigorous empirical approach. The use of Bayesian methods in particular has not been widely used in the field of HIV Prevention/PrEP use, and is usefully applied in this context to determine the influence of theoretical constructs on the outcome. In particular, the promise of MCMC algorithms to this field is illustrated.
Abstract submitted by:
Shaon Lahiri - George Washington University
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Photo Stock Editor