Application of the Information-Motivation-Behavioral Skills Theory to Explore HIV Self-Testing Behavior Among Men Who Have Sex with Men in Southwest China.

Abstract

HIV self-testing (HIVST) has been shown to complement existing facility-based testing services and promote regular HIV testing among men who have sex with men (MSM). However, HIVST uptake among Chinese MSM remains suboptimal, with existing studies reporting a testing rate below 50%. While the Information-Motivation-Behavioral Skills (IMB) model has often been employed to understand health behaviors, its application to quantitatively investigate HIVST remains limited. An anonymous cross-sectional survey was conducted among 499 eligible MSM in Chengdu, China, from March to May 2022. The psychometric properties of the IMB components were validated using confirmatory factor analysis and Analysis of Moment Structures. The associations between IMB factors and HIVST were explored through univariate and multivariate logistic regression analyses. Factors identified in the regression analyses were subsequently included in a structural equation modeling framework. A total of 178 individuals (35.7%) reported HIVST in the last 6 months. Higher self-testing knowledge (adjusted odds ratio, aOR = 1.54, 95% CI: 1.07-2.23), positive attitudes toward self-testing-specifically regarding test accuracy (aOR = 1.29, 95% CI: 1.02-1.63) and confidentiality (aOR = 1.33, 95% CI: 1.10-1.62)-and greater behavioral skills related to self-testing (aOR = 1.11, 95% CI: 1.04-1.20) were independently associated with higher HIVST uptake. In the IMB model, information (β = 0.118, p = 0.027), motivation (β = 0.263, p < 0.001), and behavioral skills (β = 0.149, p = 0.002) each demonstrated a direct positive effect on HIVST. Additionally, behavioral skills partially mediated the effects between information (β = 0.235, p < 0.001) and motivation (β = 0.131, p = 0.010) on HIVST. These findings indicate that interventions targeting IMB components are essential for improving HIVST uptake among Chinese MSM. In particular, health education focusing on self-testing knowledge, assurance of test kit validity, and empowerment through skill-building interventions may facilitate greater adoption of HIVST in this population.