{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:26:02Z","timestamp":1792416362671,"version":"4.4.0"},"reference-count":52,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Technology of the People\u2019s Republic of China","award":["2018ZX10721102-005"],"award-info":[{"award-number":["2018ZX10721102-005"]}]},{"name":"Ministry of Science and Technology of the People\u2019s Republic of China","award":["2018ZX10721102-005"],"award-info":[{"award-number":["2018ZX10721102-005"]}]},{"name":"Ministry of Science and Technology of China","award":["2018ZX10721102-005"],"award-info":[{"award-number":["2018ZX10721102-005"]}]},{"name":"Ministry of Science and Technology of China","award":["2018ZX10721102-005"],"award-info":[{"award-number":["2018ZX10721102-005"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Men who have sex with other men (MSMs) are at high risk of being infected by the human immunodeficiency virus (HIV) in western China. Pre-exposure prophylaxis (PrEP) is an efficient way to prevent HIV transmission. However, adherence is the most vital determinant factor affecting PrEP effectiveness. We conducted a study based on the Health Belief Model to explore factors that predict adherence to PrEP among a cohort of 689 MSMs in western China. (2) Methods: We assessed perceived susceptibility, severity, benefits, barriers, self-efficacy, cues to action, and HIV-preventive behavior through a cross-sectional survey. (3) Results: PrEP self-efficacy was directly associated with PrEP behaviors (\u03b2 = 0.221, p &lt; 0.001), cues to action were directly associated with PrEP behaviors (\u03b2 = 0.112, p &lt; 0.001), perceived benefits were directly associated with PrEP behaviors (\u03b2 = 0.101, p &lt; 0.001), and perceived susceptibility was directly associated with PrEP behaviors (\u03b2 = 0.117, p = 0.043). (4) Conclusion: Medication self-efficacy, perceived susceptibility, and cue to action structures are predictors of the MSMs\u2019 HIV-preventive behavior in western China. These results will provide theoretical plans for promoting PrEP adherence in MSMs.<\/jats:p>","DOI":"10.3390\/ijerph191610185","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T21:23:56Z","timestamp":1660771436000},"page":"10185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["The Influencing Factors of HIV-Preventive Behavior Based on Health Belief Model among HIV-Negative MSMs in Western China: A Structural Equation Modeling Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2222-1053","authenticated-orcid":false,"given":"Hui","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Yixue Road, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4716-477X","authenticated-orcid":false,"given":"Guichuan","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Yixue Road, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiqian","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Yixue Road, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8035-1841","authenticated-orcid":false,"given":"Xiaoni","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Yixue Road, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2148782","DOI":"10.1001\/jamanetworkopen.2021.48782","article-title":"Association of HIV Preexposure Prophylaxis Use With HIV Incidence Among Men Who Have Sex With Men in China: A Nonrandomized Controlled Trial","volume":"5","author":"Wang","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1080\/22221751.2021.1894904","article-title":"High population-attributable fractions of traditional risk factors for non-AIDS-defining diseases among people living with HIV in China: A cohort study","volume":"10","author":"Liu","year":"2021","journal-title":"Emerg. Microbes Infect."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yan, X., Li, Y., Su, H., Xing, Y., Zhang, B., Lu, Z., and Jia, Z. (2020). Protect MSM from HIV and other sexually transmitted diseases by providing mobile health services of partner notification: Protocol for a pragmatic stepped wedge cluster randomized controlled trial. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09162-x"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e22388","DOI":"10.2196\/22388","article-title":"Risk-Taking Behaviors and Adherence to HIV Pre-Exposure Prophylaxis in Users of Geosocial Networking Apps: Real-World, Multicenter Study","volume":"22","author":"Wang","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.2147\/RMHP.S295114","article-title":"Risk Management on Pre-Exposure Prophylaxis Adherence of Men Who Have Sex with Multiple Men: A Multicenter Prospective Cohort Study","volume":"14","author":"Liu","year":"2021","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_6","first-page":"707","article-title":"Characteristics of HIV sexually transmission and challenges for controlling the epidemic in China","volume":"39","author":"Wu","year":"2018","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ye, L., Wei, S., Zou, Y., Yang, X., Abdullah, A.S., Zhong, X., Ruan, Y., Lin, X., Li, M., and Wu, D. (2014). HIV pre-exposure prophylaxis interest among female sex workers in Guangxi, China. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0086200"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E629","DOI":"10.1016\/S2352-3018(18)30215-7","article-title":"Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: The EPIC-NSW prospective cohort study","volume":"5","author":"Grulich","year":"2018","journal-title":"Lancet HIV"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e25733","DOI":"10.1002\/jia2.25733","article-title":"Imperfect adherence in real life: A prevention-effective perspective on adherence to daily and event-driven HIV pre-exposure prophylaxis among men who have sex with men-a prospective cohort study in Taiwan","volume":"24","author":"Wu","year":"2021","journal-title":"J. Int. AIDS Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e25708","DOI":"10.1002\/jia2.25708","article-title":"Adherence to event-driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: Analysis based on online diary data, 3-monthly questionnaires and intracellular TFV-DP","volume":"24","author":"Jongen","year":"2021","journal-title":"J. Int. AIDS Soc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ijid.2018.08.006","article-title":"Adherence to pre-exposure prophylaxis among men who have sex with men: A prospective cohort study","volume":"75","author":"Qu","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"799","DOI":"10.3389\/fphar.2018.00799","article-title":"Efficacy and Safety of Oral TDF-Based Pre-exposure Prophylaxis for Men Who Have Sex With Men: A Systematic Review and Meta-Analysis","volume":"9","author":"Huang","year":"2018","journal-title":"Front. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e33877","DOI":"10.2196\/33877","article-title":"Condomless Anal Sex Associated With Heterogeneous Profiles Of HIV Pre-Exposure Prophylaxis Use and Sexual Activities Among Men Who Have Sex With Men: A Latent Class Analysis Using Sex Diary Data on a Mobile App","volume":"23","author":"Yu","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3389\/fphar.2016.00429","article-title":"Matching Adherence Interventions to Patient Determinants Using the Theoretical Domains Framework","volume":"7","author":"Allemann","year":"2016","journal-title":"Front. Pharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.2147\/PPA.S269255","article-title":"Refinement and Evaluation of a Chinese and Western Medication Adherence Scale for Patients with Chronic Kidney Disease: Item Response Theory Analyses","volume":"14","author":"Huang","year":"2020","journal-title":"Patient Prefer. Adherence"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"519","DOI":"10.2147\/IDR.S289964","article-title":"Knowledge, Attitudes, and Practices of Antimicrobial Uses and Resistance Among Public University Students in Bangladesh","volume":"14","author":"Marzan","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/j.cpr.2008.07.004","article-title":"Adherence to continuous positive airway pressure therapy in obstructive sleep apnoea sufferers: A theoretical approach to treatment adherence and intervention","volume":"28","author":"Olsen","year":"2008","journal-title":"Clin. Psychol. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"111376","DOI":"10.1016\/j.envres.2021.111376","article-title":"Exploring the predictors of health-protective behavior during the COVID-19 pandemic: A multi-country comparison","volume":"199","author":"Jadil","year":"2021","journal-title":"Environ. Res."},{"key":"ref_19","first-page":"1","article-title":"HIV testing and related factors among 50 years and older MSM in China: Results from a cross-sectional study","volume":"34","author":"Lian","year":"2022","journal-title":"AIDS Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s10461-019-02644-z","article-title":"Anticipated HIV-Related Stigma and HIV Treatment Adherence: The Indirect Effect of Medication Concerns","volume":"24","author":"Camacho","year":"2020","journal-title":"AIDS Behav."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"808338","DOI":"10.3389\/fpsyg.2022.808338","article-title":"COVID-19 Vaccination Behavior Among Frontline Healthcare Workers in Pakistan: The Theory of Planned Behavior, Perceived Susceptibility, and Anticipated Regret","volume":"13","author":"Khayyam","year":"2022","journal-title":"Front. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Li, Y., Luk, T.T., Wu, Y., Cheung, D.Y.T., Li, W.H.C., Tong, H.S.C., Lai, V.W.Y., Ho, S.Y., Lam, T.H., and Wang, M.P. (2021). High Perceived Susceptibility to and Severity of COVID-19 in Smokers Are Associated with Quitting-Related Behaviors. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010894"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"110388","DOI":"10.1016\/j.jenvman.2020.110388","article-title":"The power of the health belief model (HBM) to predict water demand management: A case study of farmers\u2019 water conservation in Iran","volume":"263","author":"Raheli","year":"2020","journal-title":"J. Environ. Manag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1136\/bjsm.2010.081406","article-title":"Implementing an exercise-training programme to prevent lower-limb injuries: Considerations for the development of a randomised controlled trial intervention delivery plan","volume":"45","author":"Finch","year":"2011","journal-title":"Br. J. Sports Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.vaccine.2020.12.083","article-title":"Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong","volume":"39","author":"Wong","year":"2021","journal-title":"Vaccine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1080\/21645515.2020.1790279","article-title":"The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay","volume":"16","author":"Wong","year":"2020","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_27","first-page":"175","article-title":"Beliefs and Perception About HIV\/AIDS, Self-Efficacy, and HIV Sexual Risk Behaviors Among Young Thai Men Who Have Sex With Men","volume":"29","author":"Khumsaen","year":"2017","journal-title":"Int. Soc. AIDS Educ."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5807162","DOI":"10.1155\/2020\/5807162","article-title":"Association between Psychological Factors and Condom Use with Regular and Nonregular Male Sexual Partners among Chinese MSM: A Quantitative Study Based on the Health Belief Model","volume":"2020","author":"Huang","year":"2020","journal-title":"Biomed Res. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/aphw.12262","article-title":"The health belief model predicts vaccination intentions against COVID-19: A survey experiment approach","volume":"13","author":"Zampetakis","year":"2021","journal-title":"Appl. Psychol. Health Well Being"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/hiv.12500","article-title":"Prevalence of and factors associated with unprotected anal intercourse with regular and nonregular male sexual partners among newly diagnosed HIV-positive men who have sex with men in China","volume":"18","author":"Wang","year":"2017","journal-title":"HIV Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e25715","DOI":"10.1002\/jia2.25715","article-title":"Prevention challenges with current perceptions of HIV burden among HIV-negative and never-tested men who have sex with men in the Netherlands: A mixed-methods study","volume":"24","author":"Zimmermann","year":"2021","journal-title":"J. Int. AIDS Soc."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Patrick, R., Jain, J., Harvey-Vera, A., Semple, S.J., Rangel, G., Patterson, T.L., and Pines, H.A. (2019). Perceived barriers to pre-exposure prophylaxis use among HIV-negative men who have sex with men in Tijuana, Mexico: A latent class analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221558"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3016","DOI":"10.1007\/s10461-022-03633-5","article-title":"Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake Among Men Who have Sex with Men Who Use Stimulants: A Qualitative Study","volume":"26","author":"Viera","year":"2022","journal-title":"AIDS Behav."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Hu, Y., Zhong, X.N., Peng, B., Zhang, Y., Liang, H., Dai, J.H., Zhang, J.Y., and Huang, A.L. (2018). Associations between perceived barriers and benefits of using HIV pre-exposure prophylaxis and medication adherence among men who have sex with men in Western China. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3497-7"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1089\/apc.2021.0146","article-title":"Health Beliefs Linked to HIV Pre-Exposure Prophylaxis Use Intention Among Young Men Who Have Sex with Men in Taiwan","volume":"35","author":"Huang","year":"2021","journal-title":"AIDS Patient Care STDS"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wang, Z., Fang, Y., Chan, P.S., Chidgey, A., Fong, F., Ip, M., and Lau, J.T.F. (2021). Effectiveness of a Community-Based Organization-Private Clinic Service Model in Promoting Human Papillomavirus Vaccination among Chinese Men Who Have Sex with Men. Vaccines, 9.","DOI":"10.3390\/vaccines9111218"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s11121-017-0824-y","article-title":"Longitudinal Predictors of Behavioral Intentions and HIV Service Use Among Men Who Have Sex with Men","volume":"19","author":"McGarrity","year":"2018","journal-title":"Prev. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wang, C., Tucker, J.D., Liu, C., Zheng, H., Tang, W., and Ling, L. (2018). Condom use social norms and self-efficacy with different kinds of male partners among Chinese men who have sex with men: Results from an online survey. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-6090-5"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1037\/hea0000617","article-title":"Condom-use self-efficacy as a mediator between syndemics and condomless sex in men who have sex with men (MSM)","volume":"37","author":"Safren","year":"2018","journal-title":"Health Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1557988319847088","DOI":"10.1177\/1557988319847088","article-title":"Influencing Factors of Pre-Exposure Prophylaxis Self-Efficacy Among Men Who Have Sex With Men","volume":"13","author":"Qu","year":"2019","journal-title":"Am. J. Mens Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"151354","DOI":"10.1016\/j.apnr.2020.151354","article-title":"The effect of mindfulness-based education given to individuals with substance-use disorder according to self-efficacy theory on self-efficacy perception","volume":"57","author":"Bayir","year":"2021","journal-title":"Appl. Nurs. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4739","DOI":"10.2147\/RMHP.S337287","article-title":"Factors Influencing the Intention of MSM to Use the PrEP Intelligent Reminder System","volume":"14","author":"Ma","year":"2021","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1265\/ehpm.22-00066","article-title":"Factors influencing HIV testing and counselling services among men who have sex with men in Western China: A cross-sectional study based on Andersen\u2019s Behavioral Model","volume":"27","author":"Lin","year":"2022","journal-title":"Environ. Health Prev. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria Versus New Alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct. Equ. Model."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1207\/s15327906mbr2404_4","article-title":"Single Sample Cross-Validation Indexes for Covariance-Structures","volume":"24","author":"Browne","year":"1989","journal-title":"Multivar. Behav. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1097\/QAD.0000000000001145","article-title":"Effectiveness and safety of oral HIV preexposure prophylaxis for all populations","volume":"30","author":"Fonner","year":"2016","journal-title":"AIDS"},{"key":"ref_47","first-page":"4789971","article-title":"Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study","volume":"2021","year":"2021","journal-title":"AIDS Res. Treat."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.4081\/jphr.2021.2339","article-title":"The relationship between self-efficacy and spirituality in condom use behaviour among MSM-PLWHA in Bandung, indonesia","volume":"10","author":"Rahim","year":"2021","journal-title":"J. Public Health Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1016\/j.pec.2016.06.014","article-title":"Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model","volume":"99","author":"Yang","year":"2016","journal-title":"Patient Educ. Couns."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Vogel, E.A., Henriksen, L., Schleicher, N.C., and Prochaska, J.J. (2021). Perceived Susceptibility to and Seriousness of COVID-19: Associations of Risk Perceptions with Changes in Smoking Behavior. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147621"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1080\/09640568.2020.1729705","article-title":"Changing rice cropping patterns among farmers as a preventive policy to protect water resources","volume":"63","author":"Boazar","year":"2020","journal-title":"J. Environ. Plan. Manag."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2310\/7060.2004.13609","article-title":"Knowledge, attitudes and practices in travel-related infectious diseases: The European airport survey","volume":"11","author":"Castelli","year":"2004","journal-title":"J. Travel Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10185\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:10:58Z","timestamp":1760141458000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,17]]},"references-count":52,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph191610185"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191610185","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,17]]}}}