Development And Testing the Predictability of An Instrument Based on The Multi- Theory Model (MTM) Of Health Behavior Change for Pre-Exposure Prophylaxis (PREP) Uptake Among People of Color

HIV/AIDS continues to be a significant public health problem in the US and globally. In the US, it disproportionately affects people of color. In 2012, Pre-exposure Prophylaxis (PrEP) was approved by the FDA for HIV prevention. PrEP reduces the chances of acquiring HIV by 99% among people at high risk. However, PrEP uptake among people of color remains low. Therefore, this study aimed to develop and test the predictability of an instrument to describe the intent to initiate and sustain PrEP use among people of color. This research utilized an exploratory sequential mixed methods design based on the fourth-generation, multi-theory model (MTM) of health behavior change. The first phase of the research involved qualitative interviews with people of color and directed content analysis to develop an instrument based on MTM for PrEP uptake behavior (n=12). The second phase involved the establishment of face validity, content validity, and qualitative construct validity through two rounds of expert panel validation. The third phase of the research involved quantitative testing of construct validity using structural equation modeling and predictive validity through hierarchical multiple regression (n=225). The findings revealed that the constructs of behavioral confidence (β=0.439, p<0.0001), and perceived changes in the physical environment (β=0.253, p=0.002) were significantly associated with the intent to initiate PrEP. This model accounted for 55% of the variance. Emotional transformation (β=0.194, p=0.041), practice for change (β=0.273, p=0.004), and changes in the social environment (β=0.315, p=0.001) were significantly associated with sustaining PrEP usage. This model accounted for 46% of the variance. Future researchers can utilize the MTM-based instrument for designing and testing interventions to bridge the gap of new HIV infections using PrEP among communities of color.