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Framed Messages to Increase Condom Use Frequency Among Individuals Taking Daily Antiretroviral Medication for Pre-exposure Prophylaxis

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Abstract

PrEP delivery and routine care provide a unique opportunity to promote sexually transmitted infection (STI) prevention by both increasing STI testing frequency and creating a space for affirmative and effective safer sex counseling. This study was a feasibility and acceptability pilot of an adapted framed message intervention to increase condom use frequency with PrEP. In the formative phase, two focus groups with PrEP users (N = 7) provided feedback on a provisional loss-framed message intervention and identified potential study barriers. In the pilot trial, the adapted loss-framed message intervention was compared to a gain-framed message intervention and enhanced skills condition in a sample of PrEP users (N = 29). In terms of intervention feasibility, 58% of approached PrEP users completed the eligibility screen; 79% of those eligible enrolled in the study and 66% of enrolled participants completed the three-month follow-up. In terms of intervention acceptability, participants found the informational messages, regardless of assignment, to be moderately interesting (M = 6.24, SD = 2.97) and useful (M = 7.07, SD = 3.00), and very easy to understand (M = 9.50, SD = 0.97) on Likert-type scales ranging from 1 to 10. In terms of intervention effects, there was a small effect of the gain-framed intervention (b = .58, SE = .93, CI = -1.33, 2.48, Cohen’s d = .26) on HIV/STI risk transmission. There was a small-medium effect of both the loss- (b = 2.00, SE = .90, CI = .15, 3.85, Cohen’s d = 1.46) and gain-framed (b = 2.24, SE = .93, CI = .34, 4.15, Cohen’s d = 1.65) interventions on condom use motivation. Finally, there was a medium-large effect of both the loss- (b = .97, SE = 1.33, CI = -1.88, 3.82, Cohen’s d = .54) and gain-framed intervention (b = 1.97, SE = 1.33, CI = -.88, 4.82, Cohen’s d = .87) on condom use frequency. Further refinement and testing, in a larger -scale trial with higher ecological validity than this initial pilot intervention, is warranted.

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Notes

  1. Education was not associated with any of the outcome variables and, therefore, was not included in primary analyses.

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Authors and Affiliations

  1. Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA

    Jacklyn D. Foley

  2. Department of Psychology, Syracuse University, Syracuse, NY, USA

    Jacklyn D. Foley, Madison Firkey, Alan Sheinfil, Jeremy Ramos, Sarah E. Woolf-King & Peter A. Vanable

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (exempt due to less than minimal risk and anonymous surveys: Antioch College: 201802; California State University: 18-19-242; University of Kansas; University of Michigan) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Foley, J.D., Firkey, M., Sheinfil, A. et al. Framed Messages to Increase Condom Use Frequency Among Individuals Taking Daily Antiretroviral Medication for Pre-exposure Prophylaxis. Arch Sex Behav 50, 1755–1769 (2021). https://doi.org/10.1007/s10508-021-02045-1

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