Combining theory and technology to reduce individual barriers to sexual health promotion: lessons learned from an online hepatitis B vaccination promotion intervention in MSM
P.C. Adam1,2, J. de Wit1,3, H. Baudoin4, C. Barbier5
1University of New South Wales, National Centre in HIV Social Research, Sydney, Australia, 2Institute for Prevention and Social Research, Utrecht, Netherlands, 3Utrecht University, Dept. of Social and Organizational Psychology, Utrecht, Netherlands, 4Association Sida Info Service, Paris, France, 5Direction Générale des Affaires Sanitaires et Sociales d’Ile-de-France, Paris, France
Background: Despite existing recommendations and initiatives to promote vaccination against hepatitis B, a significant minority of French MSM is still not vaccinated. Using theorizing in health psychology, we developed an online intervention (www.unvaccinpourlesgays.fr) aimed at providing information, reducing perceived barriers and motivating MSM to obtain vaccination.
Methods: Participants were recruited through a major gay Internet site and men eligible for vaccination were enrolled in an online RCT. Arm 1 (control condition; CC) provided information about hepatitis B and vaccination. Arm 2 contained identical information and also addressed perceived barriers. Arm 3 provided information and in addition supported men in planning to obtain vaccination. Arm 4 delivered the full intervention. After exposure, the impact of the program components on perceived barriers, intention and perceived self-efficacy regarding vaccination was assessed.
Results: A third of the 2,040 MSM who initiated the survey up until 1 February 2010 were eligible for hepatitis B vaccination. Of these, 600 men provided complete data. The full intervention (4th arm) was found to reduce perceived barriers to vaccination (2.5 vs. 2.8 for CC, p=.001; theoretical range: 1-7) and to increase both intention to vaccinate (5.2 vs. 4.6 for CC, p=.006) as well as perceived self-efficacy (5.8 vs. 5.5 for CC, p=.028). The impact on actual vaccination will be assessed at Month 3 (March 2010).
Conclusions: Behaviour change programs are more effective when they go beyond information and address other aspects of motivation and action initiation. The strategy employed in the present brief intervention, which consisted of addressing known perceived barriers to vaccination and supporting planning to obtain vaccination, was found to be effective in motivating men and holds substantial promise for health promotion in other domains, in particular HIV prevention. Achieving high impact with behaviour change interventions is relatively easy when relevant theorizing and technologies are combined.