Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men.

In the U.S., HIV incidence is highest among Black men who have sex with men (MSM) but PrEP uptake is low, in part due to lack of normative support for using PrEP. This research pilot tested a social network-level intervention designed to increase PrEP use willingness, interest, and peer supports among Black MSM in Milwaukee. Five community social networks (n = 40 participants) of racial minority MSM were assessed at baseline with measures of PrEP knowledge, interest, attitudes, and action taking. Persons most interconnected with others in each network attended an intervention that provided training to increase knowledge about PrEPbenefits, address PrEP concerns, endorse PrEP use as a symbol of pride and health, and deliver these messages to others in their social networks. All network members were re-administered the same measures at 3-month followup. Significant increases over time were found in network members' PrEP knowledge, attitudes, norm perceptions, self-efficacy, and willingness to use PrEP. Participants more often talked with friends about HIV and with their health care providers about PrEP. The percentage of participants who reported using PrEP increased from 3% to 11%. Larger-scale evaluations of this intervention model are needed.

Assessing medication adherence self-efficacy among low-literacy patients: development of a pictographic visual analogue scale.

Health behavior interventions are often grounded in Social Cognitive Theory, but instruments used to assess self-efficacy rely on verbal skills and yield scores that are highly positively skewed. Based on a review of the research literature and qualitative research with key informants, a pictographic medication adherence self-efficacy scale was developed. Two studies were conducted to test the pictographic and color visual analogue scale for assessing self-efficacy for medication adherence. Study 1 (N = 81) demonstrated that the pictographic self-efficacy scale was internally consistent (alpha = 0.68), time stable (2-week test-re-test r = 0.63), and showed evidence for convergent and divergent construct validity. Study 2 (N = 64) further supported the reliability of the pictographic self-efficacy scale with additional data supporting its convergent, divergent and criterion-related validity, including associations with medication adherence and HIV viral load. Distributions of self-efficacy scores approximated normal. This newly developed pictographic scale may be useful in assessing medication adherence self-efficacy in lower-literacy populations.