Factors associated with behavioral intention to undergo routine chlamydia trachomatis screening among men who have sex with men in China: an application of the theory of planned behavior

Background Chlamydia trachomatis (CT) is one of the most common sexually transmitted infections (STIs), and screening uptake remains low among men who have sex with men (MSM), in whom most infections are asymptomatic. This study applied an extended Theory of Planned Behavior (TPB) framework to identify factors associated with behavioral intention to undergo routine CT screening among MSM in China. Methods A cross-sectional survey was conducted between May 2023 and April 2025 at an STD clinic and a non-governmental organization in Shenzhen. A structured questionnaire collected sociodemographic information and extended TPB constructs, including attitude, subjective norm (subdivided into descriptive, prescriptive, and moral norms), perceived behavioral control (PBC), and perceived risk. Behavioral intention was measured on a 5-point Likert scale and treated as a continuous variable. Pearson's correlation and hierarchical multiple linear regression were used to examine the associations between TPB constructs and behavioral intention after adjustment for sociodemographic and behavioral variables. Results Of 492 MSM enrolled, 488 completed the survey (completion rate 99.19%), and 77.87% reported behavioral intention to undergo routine CT screening. In the fully adjusted model, attitude (β = 0.329, p < 0.001) and PBC (β = 0.333, p < 0.001) showed the strongest positive associations with behavioral intention; moral norm was also positively associated (β = 0.083, p = 0.017), whereas perceived risk (β = −0.083, p = 0.010) and descriptive norm (β = −0.068, p = 0.037) showed negative associations. The final model explained 57.6% of the variance in behavioral intention. Conclusions Behavioral intention to undergo routine CT screening was high among MSM. Attitude and PBC were the main TPB constructs associated with this intention, and moral norm was also positively associated, whereas perceived risk and descriptive norm showed negative associations, supporting the value of the extended TPB framework. Interventions to promote CT screening among MSM should prioritize strengthening positive attitudes toward screening and enhancing perceived control over access to testing services.