Applying the theory of planned behaviour to explain HIV testing in antenatal settings in Addis Ababa - a cohort study

Abstract

BackgroundTo facilitate access to the prevention of mother-to-child HIV transmission (PMTCT) services, HIV counselling and testing are offered routinely in antenatal care settings. Focusing a cohort of pregnant women attending public and private antenatal care facilities, this study applied an extended version of the Theory of Planned Behaviour (TPB) to explain intended- and actual HIV testing.MethodsA sequential exploratory mixed methods study was conducted in Addis Ababa in 2009. The study involved first time antenatal attendees from public- and private health care facilities. Three Focus Group Discussions were conducted to inform the TPB questionnaire. A total of 3033 women completed the baseline TPB interviews, including attitudes, subjective norms, perceived behavioural control and intention with respect to HIV testing, whereas 2928 completed actual HIV testing at follow up. Data were analysed using descriptive statistics, Chi-square tests, Fisher's Exact tests, Internal consistency reliability, Pearson's correlation, Linear regression, Logistic regression and using Epidemiological indices. P-values < 0.05 was considered significant and 95% Confidence Interval (CI) was used for the odds ratio.ResultsThe TPB explained 9.2% and 16.4% of the variance in intention among public- and private health facility attendees. Intention and perceived barriers explained 2.4% and external variables explained 7% of the total variance in HIV testing. Positive and negative predictive values of intention were 96% and 6% respectively. Across both groups, subjective norm explained a substantial amount of variance in intention, followed by attitudes. Women intended to test for HIV if they perceived social support and anticipated positive consequences following test performance. Type of counselling did not modify the link between intended and actual HIV testing.ConclusionThe TPB explained substantial amount of variance in intention to test but was less sufficient in explaining actual HIV testing. This low explanatory power of TPB was mainly due to the large proportion of low intenders that ended up being tested contrary to their intention before entering the antenatal clinic. PMTCT programs should strengthen women's intention through social approval and information that testing will provide positive consequences for them. However, women's rights to opt-out should be emphasized in any attempt to improve the PMTCT programs.

Exposure to HIV/AIDS-Related Media Content and HIV Testing Intention: Applying the Integrative Model of Behavioral Prediction

“…In the population sample, individual understanding regarding the extent of HIV testing among their referent others (descriptive norms) and perceived pressure to perform the behavior (injunctive norms) seem to be of paramount importance. The fact that normative beliefs overpower attitudinal and self-efficacy beliefs in determining HIV testing behavior in this population has been indicated by previous research (e.g., Mirkuzie, Sisay, Moland & Å strøm, 2011). In this context, it has been argued that people are more likely to test for HIV if they perceive that social norms promote testing and if they anticipate social support as a consequence of undergoing testing.…”

Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania

“…The IBM was adopted in this study because it includes constructs from other influential behavioral theories such as the Theory of Reasoned Action (TRA), the Theory of Planned Behavior (TPB), Social Cognitive Theory (SCT), and the Health Belief Model (HBM), all of which emphasize that value and expectancy beliefs guide behavior [30,31,[33][34][35]. Existing evidence suggests that the IBM framework focuses on determinants associated with HIV prevention behaviours, such as HIV testing [35][36][37][38] (Fig. 1).…”

High risk men who have sex with men in Spain are reporting low intentions of actively seeking HIV testing: results from a cross-sectional study

“…Social cognition models, such as the theory of the planned behaviour [16] consider that the likelihood of carrying out a behaviour depends on the strength of the intention. Applied to HIV testing, this means that CIT is linked to the strength of testing intentions as evidence indeed suggests [17]. If an individual has low intentions of actively seeking an HIV test, these strategies might not be effective [18].…”