Judith Ann Levy, Chair and Advisor Joan Kennelly, Community Health Sciences Sage Kim, Health ...

160 Pages·2017·2.67 MB·English

Information Exposure to HIV Testing Technologies and Testing Intentions among
Undergraduates in Beijing

BY

MENG JIA
B.S., China Pharmaceutical University, 2009
M.S., Peking University, Beijing, 2012

THESIS

Submitted as partial fulfillment of the requirements
for the degree of Doctor of Philosophy in Public Health Sciences
in the Graduate College of the
University of Illinois at Chicago, 2017

Chicago, Illinois

Defense Committee:

Judith Ann Levy, Chair and Advisor
Joan Kennelly, Community Health Sciences
Sage Kim, Health Policy and Administration
Janet Lin, Emergency Medicine
Saria S, Awadalla, Epidemiology and Biostatistics
ACKNOWLEDGMENTS

I am indebted to my advisor and mentor Judith Ann Levy who has helped me hone my
skills as a researcher. Without her faith in my abilities, I would not have been able to come so far.
Her expertise and passion for research inspires me every day.

I would like to thank my thesis committee—Joan Kennelly, Sage Kim, Janet Lin and
Saria Awadalla--for their unwavering support and assistance. They provided guidance in all
areas that helped me accomplish my research goals and enjoy myself in the process.

I would also like to acknowledge my advisor at Peking University in China, Peiyu Wang.
The data collection required for this study would not have been possible without his generous
support.

I am also very grateful to the project director for our training program, Saima Chaudhry,
who oversaw the development of the IRB application and made contributions important to the
conduct of the study.

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ACKNOWLEDGMENTS (continued)

A number of individuals in the data collection site were extremely helpful to me during
data collection process, and I would like to thank them as well -- at the Peking University Health
Science Center, Yu Mei Zhang, and the staffs of Department of Social Medicine and Health
Education; at Peking University Health Center Medical Center, Yang Wang; at University of
Illinois at Chicago, Eric Umar, Yi Li, Piing Ji, Yang Li, and other trainees from the AIDS
International Research and Training Program. Others who were helpful were the attending staff
and fellows in School of Public Health at the University of Illinois at Chicago.

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TABLE OF CONTENTS

CHAPTER PAGE

I. INTRODUCTION ................................................................................................................... 1
A. Background ....................................................................................................................... 1
1. HIV/AIDS epidemic in young adults in China .............................................................. 1
2. HIV risks among college students in China ................................................................ 2
3. HIV testing strategies in China .................................................................................... 3
4. HIV self/home tests ..................................................................................................... 7
5. HIV testing among college youths in China ................................................................ 9
B. Statement of the Problem ............................................................................................... 11
C. Significance of the Problem ............................................................................................ 11
D. Purpose of the Study ....................................................................................................... 12
E. Significance of the Study ................................................................................................. 14

II. CONCEPTUAL FRAMEWORK AND RELATED LITERATURE ......................................... 16
A. The Role of Information in Health Behavior .................................................................... 16
B. Theories Used to Study Health Information and Behavior .............................................. 18
C. TPB Model constructs relavent to HIV testing behaivor .................................................. 25
1. Attitudes toward HIV testing ...................................................................................... 25
2. Subjective norms ...................................................................................................... 27
3. Perceived behavioral control ..................................................................................... 28
4. Non-TPB predictors of HIV testing ............................................................................ 29
a. Perceived risk of HIV infection .............................................................................. 29
b. Personal characteristics ........................................................................................ 30
D. Informational Components Relevant to HIV Testing ....................................................... 30
1. Knowledge of HIV testing .......................................................................................... 31
2. Awareness of testing formats .................................................................................... 33
3. Information behavior ................................................................................................. 33
a. Information seeking ............................................................................................... 34

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TABLE OF CONTENTS (continued)

CHAPTER PAGE

b. Information exposure ............................................................................................. 34
E. Research Model and Proposed Hypothesis .................................................................... 35

III. METHODS ...................................................................................................................... 39
A. Study Setting ................................................................................................................... 39
B. Sample ............................................................................................................................ 39
1. Sampling frame ......................................................................................................... 39
2. Power Calculations ................................................................................................... 40
C. Sample Recruitment ........................................................................................................ 42
1. Sample for pilot testing the study’s measures and questionaire ............................... 42
2. Study sample ............................................................................................................ 43
D. Study Measures .............................................................................................................. 46
1. The study’s dependent: HIV testing intention ........................................................... 48
2. Information constructs ............................................................................................... 48
a. Information seeking ............................................................................................... 48
b. Information exposure ............................................................................................. 48
c. Awareness of rapid HIV test technology ............................................................... 49
d. Self-rated knowledge of novel HIV tests ............................................................... 49
3. TPB constructs .......................................................................................................... 49
a. Attitude toward HIV testing .................................................................................... 49
b. Subjective norms regarding HIV testing ................................................................ 51
c. Perceived behavioral control ................................................................................. 52
4. Other constructs ........................................................................................................ 54
a. Perceived risk ........................................................................................................ 54
b. Personal characteristics ........................................................................................ 54
c. Preferences for HIV testing ................................................................................... 54
E. Statistical Analysis .......................................................................................................... 55
1. Data coding and management .................................................................................. 55

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TABLE OF CONTENTS (continued)

CHAPTER PAGE

2. Variable descriptions and values .............................................................................. 56
3. Missing data processing ........................................................................................... 57
4. Data analysis ............................................................................................................ 57
a. Descriptive analyses ............................................................................................. 57
b. Bivariate analysis .................................................................................................. 59
c. Regression analysis .............................................................................................. 59

IV. RESULTS ........................................................................................................................ 61
A. Univariate Analysis .......................................................................................................... 61
1. Participants characteristics ....................................................................................... 61
a. Demographics ....................................................................................................... 61
b. Sexual related behaviors ....................................................................................... 62
c. HIV testing behavior and preferences ................................................................... 62
2. Outcome variable: HIV testing intention .................................................................... 63
3. Information constructs ............................................................................................... 71
4. TPB constructs .......................................................................................................... 72
B. Bivariate Analysis ............................................................................................................ 79
C. Mutivariate Analysis ........................................................................................................ 81
D. Path Analysis .................................................................................................................. 81
1. Analytic model of the total mediated effect ............................................................... 83
2. Modified model with direct effect included ................................................................ 84
E. Examination of Variable Distributions Among MSM Students......................................... 92

V. DISCUSSION ...................................................................................................................... 93
A. TPB Applicatibity for HIV Testing Intentions ................................................................... 93
B. Implications and Future Research .................................................................................. 97
C. Limitations ....................................................................................................................... 99
D. Conclusions ................................................................................................................... 102

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TABLE OF CONTENTS (continued)

CHAPTER PAGE

APPENDICES ........................................................................................................................... 104
Appendix A ............................................................................................................................ 105
Appendix B ............................................................................................................................ 116
Appendix C ........................................................................................................................... 123
Appendix D ........................................................................................................................... 127
Appendix E ............................................................................................................................ 128

CITED LITERATURE ................................................................................................................ 132

VITA .......................................................................................................................................... 144

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LIST OF TABLES

TABLE PAGE
I. THEORIES OF COMMUNICATION EFFECTS ON BEHAVIORS ……………… 20
II. SUMMARY OF INFORMATIONAL TERMS MEASURED IN HIV TESTING
BEHAVIOR STUDIES………………………………………………………………… 31

III. CLASSES AND NUMBER OF PARTICIPANTS…………………………………….. 45
IV. SUMMARY OF MEASURES USED IN THE STUDY……………………………….. 47
V. PRE-TESTED PSYCHOMETRIC PROPERTIES FOR ATTITUDE
SUBSCALES……………………………………………………………………………. 51

VI. SUBJECTIVE NORMS DIMENSION AND ITEMS………………………………….. 52
VII. INDIRECT MEASURES IN PERCEIVED CONTROL BELIEFS
CONSTRUCT…………………………………………………………………………… 53
VIII. ITEMS USED TO MEASURE THE PREFERENCES FOR HIV TESTING………. 55
IX. PARTICIPANTS CHARACTERISTICS: DEMOGRAPHICS……………………… 64
X. PARTICIPANTS CHARACTERISTICS: SEXUAL RELATED BEHAVIOR……….. 65
XI. HIV TESTING BEHAVIOR AND PREFERENCES………………………………….. 66
XII. HIV TESTING INTENDER AND NON-INTENDER…………………………………. 67
XIII. HIV TESTING INTENTION AMONG SUB-POPULATIONS……………………… 68
XIV. SPEARMAN CORRELATION COEFFICIENTS FOR CHARACTERISTICS
ASSOCIATED WITH HIV TESTING INTENTION…………………………………… 74

XV. DESCRIPTIVES FOR HIV TESTING INFORMATIONAL CONSTRUCTS………. 75

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LIST OF TABLES (continued)

TABLE PAGE

XVI. DIFFERENCES IN INFORMATION VARIABLES AMONG
SUB-POPULATIONS……………………………………………………………… 76
………

XVII. SUMMARY OF SCALES MEASURING KEY CONSTRUCTS………………… 77
XVIII. SUMMARY TABLE FOR TPB CONSTRUCT VARIABLES…………………… 78
XIX. SPEARMAN CORRELATIONS BETWEEN TPB CONSTRUCTS/DOMAINS
AND HIV TESTING INTENTION………………………………………………… 80
XX. INTERCORRELATIONS AMONG STUDY VARIABLES……………………… 80
XXI. ORDERED LOGISTIC REGRESSION COEFFICIENTS……………………… 82
XXII. RESULTS FOR THE DETERMINANTS OF INTENTIONS USING PATH
ANALYSIS -MODEL(I)……………………………………………………………… 86
XXIII. INDIRECT EFFECTS OF INFORMATIONAL VARIABLES ON HIV TESTING
INTENTIONS………………………………………………………………………… 87

XXIV. RESULTS FOR THE DETERMINANTS OF INTENTIONS USING PATH
ANALYSIS - MODEL (II)……………………………………………………………. 89
XXV. DIRECT AND INDIRECT EFFECTS OF INFORMATIONAL VARIABLES ON
HIV TESTING INTENTIONS……………………………………………………….. 90
XXVI. TOTAL, DIRECT AND INDIRECT PATH COEFFICIENTS FOR THE
ADAPTED MODEL………………………………………………………………….. 91
XXVII. VARIABLE STRUCTURE AND DESCRIPTION…………………………………. 117

XXVIII. MISSING DATA PATTERNS………………………………………………………. 119

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LIST OF TABLES (continued)

TABLE PAGE

XXIX. DISTRIBUTION OF CHARACTERISTICS AMONG STUDY SAMPLE AND
ELIMINATED OBSERVATIONS WITH MISSING DATA……………………….. 121
XXX. DIFFERENCES IN CHARACTERISTICS AMONG HOMOSEXUAL MALE
STUDENTS AND OTHER GROUPS……………………………………………… 122

XXXI. FACTOR LOADINGS AND SMC FOR THE THREE FIRST-ORDER
DIMENSIONS OF ATTITUDE……………………………………………………… 126

XXXII. FACTOR LOADINGS AND SMC FOR THE INFORMATION EXPOSURE…... 126

XXXIII. FACTOR LOADINGS AND SMC FOR PERCEIVED BEHAVIORAL
CONTROL……………………………………………………………………………. 126

XXXIV. MODEL SPECIFICATIONS FOR PATH ANALYSIS……………………………. 127
XXXV. COMPARISONS OF MODEL FIT INDICES BETWEEN COMPLETE-CASE
AND MI ANALYSES………………………………………………………………… 127

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