Information motivation behavioral skills model-

Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 18 June Published 12 January Volume Pages 75— Review by Single-blind.

Information motivation behavioral skills model

Information motivation behavioral skills model

Information motivation behavioral skills model

Information motivation behavioral skills model

Peer reviewers approved by Dr Amy Norman. Updated July 22, Information—motivation—behavioral skills conceptual model. Washington, DC: U. The information—motivation—behavioral skills IMB bbehavioral of health behavior change is a theoretical model that was developed to predict HIV preventive behavior. National Center for Biotechnology InformationU.

Parametric survival model sas. Introduction

Empirical tests of an information-motivation-behavioral skills model of Information motivation behavioral skills model behavior with Information motivation behavioral skills model men and heterosexual university students. Alternate Sources. The recently developed information-motivation-behavioural skills model IMB model 67,68borrowed elements from earlier work to construct a conceptually based, generalizable, and simple model to guide thinking about complex health behaviours. Intervening in the five dimensions. Predictors of adherence. ENW EndNote. Harman Published DOI: Section I - Setting the scene. SAS Institute, Inc. They outlined five general theoretical perspectives on adherence: - biomedical perspective; - behavioural perspective; - communication perspective; - cognitive perspective; and - self-regulatory perspective. Factors affecting adherence and interventions used to improve it. Correlates of adherence. Behaviora of Applied Social Psychology. Informafion andposttreatment 16 months after baseline data were collected on condom use information, motivation social norms, attitudes, intentions, and perceived riskenactment of behavioral skills condom negotiation and procurementand rates of condom use in Free dating personals elk river idaho past 2 months. Psychology Published DOI:

The information—motivation—behavioral skills IMB model is useful for understanding sexual risk behavior, but has not been tested with hazardously-drinking sexually transmitted infection STI clinic patients, a subpopulation at greater HIV risk, or with a network-perspective sexual risk behavior outcome.

  • Leventhal and Cameron 52 provided a very useful overview of the history of adherence research.
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The information—motivation—behavioral skills IMB model is useful for understanding sexual risk behavior, but has not been tested with hazardously-drinking sexually transmitted infection STI clinic patients, a subpopulation at greater HIV risk, or with a network-perspective sexual risk behavior outcome.

Sexual risk behavior SRB was operationalized as a latent variable with three indicators: 1 number of sexual partners, 2 number of unprotected sex occasions with primary partner, and 3 number of unprotected sex occasions with non-primary partner s.

Preliminary analyses suggested SRB was best operationalized as a latent variable with two indicators, while unprotected sex with primary partners should be considered separately. In structural models with good fit, the IMB model was generally supported. The IMB model functioned differently for non-primary and multiple partners compared to primary partners in STI clinic patients with hazardous alcohol use.

STI clinic patients, in particular, are in need of additional attention given their inherent elevated risk for infection and repeat infection [ 3 — 5 ]. Individuals with repeated or untreated infections are at greater risk for medical complications including infertility, ectopic pregnancy, and pelvic inflammatory disease [ 6 ]. Patients that continually acquire STIs are also at risk for contracting HIV through continued engagement in sexual risk behavior, and additional evidence suggests an epidemiological synergy with STIs that increases risk for HIV by two- to five-fold regardless of symptomology [ 7 — 9 ].

Physiologically, alcohol use reduces immune function, which makes the likelihood of seroconversion higher upon exposure to HIV [ 10 ]. Behaviorally, the causal pathway between alcohol use and sexual risk behavior is less clear. Higher risk of HIV and other STIs in the context of alcohol use could be the result of behavioral disinhibition, decreased condom-use skills, or attitudes during sex after alcohol consumption, but proposed mediating third variables e.

Although research into the causal mechanisms explaining the association between alcohol use and STI risk is still ongoing, alcohol use is associated with increased sexual risk-taking among STI clinic patients [e.

Given the limited resources in many STI clinic settings, offering intensive interventions targeting both alcohol risk reduction and sexual risk in addition to providing STI counseling and testing services may not be feasible. For this reason, it is important to identify the key predictors of HIV and STI risk behavior for alcohol-using clinic patients.

Testing theory-based models of risk behavior specifically within this sub-population of STI clinic patients may provide direction for researchers and public health practitioners alike. These findings suggest that alcohol-using STI clinic patients could represent a noteworthy proportion of total patients within some public STI clinics in the US. These patients may be in need of different intervention strategies compared to patients who do not engage in hazardous alcohol use.

Theory-based research is common in the area of STI and HIV prevention, and many prevention interventions have been based on the information—motivation—behavioral skills IMB model [ 14 , 15 ]. Now frequently used, the IMB model posits that individuals must be informed, motivated, and behaviorally skilled to initiate and maintain HIV prevention behavior. Specifically, individuals must have information that is relevant to the transmission and prevention of STIs and easy to apply in their social setting.

Motivation to engage in risk reduction and HIV prevention activities must be supported by individual attitudes and perceived social norms, and highly motivated and informed individuals must have the skills to perform the HIV prevention activity, including self-efficacy, to effectively reduce their risk for HIV and other STIs see Fig.

Information—motivation—behavioral skills conceptual model. Note information—motivation—behavioral skills model adapted from Fisher et al. IMB model research is specifically needed with alcohol-using STI clinic patients because theoretical predictors of sexual risk behavior may operate differently with this unique high-risk population.

The IMB model has not been widely used in predicting sexual risk behavior for alcohol users; rather, IMB model antecedents that view intentions as the largest determinant of health behavior [e.

For example, researchers find robust evidence in support of an association between alcohol consumption and higher intentions to engage in unprotected sex, which is moderated by heightened sexual arousal, in meta-analytic review [ 18 ].

Despite the similarities in theoretical constructs e. Intentions are instead a component of the motivational construct of the IMB model that is hypothesized to operate through behavioral skills before behavioral action is taken.

Therefore, we believe it is necessary to test the IMB model with this high-risk sample of alcohol users to determine the role of other theoretical constructs—mainly behavioral skills—in mediating the association between intentions and other motivations and sexual risk behavior.

Since conceptualization, the IMB model for HIV prevention has been widely tested using structural equation modeling SEM , which allows for the use of latent constructs to reduce the influence of measurement error along with the simultaneous consideration of associations between multiple constructs [ 19 , 20 ]. However, the measurement of risk is a weakness of prior tests of the IMB model. Previous research has suggested that predictors of unprotected sex may differ for events involving primary versus non-primary partners.

For example, Senn et al. This study found no significant associations between partner dependence and unprotected sex frequency or proportion with non-steady partners, suggesting the necessity of separately considering sexual risk events with primary and non-primary partners.

For example, Mittal et al. A broader conceptualization of risk behavior includes both number of sexual partners and number of unprotected sex events, aligning with a sexual network perspective that places individuals at higher risk for an STI with each additional partner. As such, we use outcome frequency measures to account for proximal sexual network size and each sexual risk event, a conceptual priority within our sexual network perspective.

The current study aims to model the IMB model using a sexual network perspective latent variable. Viewed from a network perspective, sexual risk may differ based on the number of sexual partners, number of unprotected sexual occasions with a primary partner, and number of unprotected sexual occasions with non-primary partner s.

We are not the first to modify the dependent variable in testing the IMB model to account for additional sexual risk measurement. Mustanski et al. Within this risk indicator, number of sexual partners and consistency in condom use were measured. Bazargan et al. Nonetheless, both of these indicators were limited when attempting to account for each specific sexual risk event, a conceptual priority within our sexual network perspective.

Given elevated sexual risk-taking and HIV risk among STI clinic patients who are hazardous alcohol users and the need to identify key intervention targets for this population, we tested the IMB model in a sample attending a Midwestern public STI clinic for confidential HIV counseling and testing. The purpose of this research is not intended to add further evidence to the relationship between alcohol use and sexual risk behavior, but rather to test a theory-based model of risk behavior within a unique population—STI clinic patients with a history of hazardous alcohol use—and perspective using a latent outcome variable with multiple measures of risk.

In line with the IMB model, we hypothesized that higher HIV prevention information and motivation would predict higher HIV prevention behavioral skills; higher behavioral skills, in addition to higher information and motivation, would then predict lower sexual risk behavior.

Thus, behavioral skills would partially mediate the relationships between information and risk behavior and between motivation and risk behavior. Key innovations of the current study included the unique, high-risk sample and the multidimensional conceptualization of sexual risk behavior.

Participants were recruited from a large, Midwestern public STI clinic as part of enrollment into a randomized controlled trial. Participants had a mean age of Scales were used to measure IMB model constructs.

Information and behavioral skills were measured as individual indicators with a single scale each, and motivation was measured by scales of condom social norms, condom attitudes, and condom intentions.

Dependent variables within our model included count data of sexual partners and unprotected sexual occasions. The IMB model construct motivation was measured using three indicator scales of condom social norms, condom attitudes, and condom intentions. Social norms were measured using a 6-item survey with 6-point semantic differential response categories from strongly disagree to strongly agree.

Eight items measured self-efficacy with responses of not at all confident to completely confident scored from 0 to Self-efficacy has been frequently used as a proxy for behavioral skills within the IMB model literature [ 22 — 25 , 27 , 28 , 30 , 32 , 35 , 36 , 43 — 49 ]. Motivation is estimated using the three indicator variables, as is sexual risk behavior.

Motivation and information are allowed to covary. We include direct paths from information and motivation to sexual risk behavior as well as indirect paths from these constructs to behavior through behavioral skills as conceptualized in the IMB model by Fisher and Fisher [ 14 ]. Model fit was determined using multiple, established fit indices. Covariances in lower left, variances along diagonal, and correlations in upper right italicized; covariances and variances were standardized for variables 1—5, and variable 1 is not equal to one due to rounding.

We originally conceptualized sexual risk behavior as a latent construct with three indicators: 1 number of sexual partners, 2 number of unprotected sex occasions with primary partner, and 3 number of unprotected sex occasions with non-primary partner s. We therefore included unprotected sex with primary partners as a separate outcome variable.

We postulated the low factor loading for primary partners and model misfit to be the result of potential differences in behavioral scripts between primary and non-primary partners. Individuals with multiple partners, and thus non-primary sexual partners, may engage in different behavior and negotiate condom use differently based on an appraisal of risk or relationship closeness [ 30 , 53 ].

Therefore, we respecified this model of sexual risk behavior into two separate models of risk: 1 sexual risk behavior with outside partners, and 2 sexual risk behavior with primary partners. After respecification, the final models retained had good model fit.

The path diagram of this first respecified model is illustrated in Fig. Because we were also interested in sexual risk behavior with primary partners, we tested an un-nested comparison model of unprotected sex with primary partners excluding number of sexual partners and unprotected sex occasions with non-primary partners.

The full path diagram of this second final model is illustrated in Fig. Standardized beta coefficient estimates, standard errors, and z-scores from structural equation models. Our preliminary model of sexual risk behavior using a sexual network perspective resulted in a structural equation model with less than ideal fit. This lack of acceptable model fit was not the result of the IMB model, rather our hypothesized conceptualization of risk.

Model fit significantly improved when we separated unprotected sex with primary partners from the other two sexual risk behavior indicators, suggesting low correlation between primary partner risk and the other outcome variables.

Another contributing factor to modest model fit within our preliminary model could be the result of a difference in how behavioral skills operated within the IMB model between non-primary and multiple partners compared to primary partners. These findings suggest the IMB model may predict behavior differently for non-primary and multiple partners as compared to primary partners for this high-risk population.

Specifically, we found that behavioral skills had the expected negative correlation with risk behavior with non-primary and multiple partners, but a positive association with the number of unprotected sexual acts with main partners. This finding is consistent with some research that suggests different predictors of sexual risk for primary and non-primary partners [ 30 ]. While we identify some potential congruence of our findings with prior research, additional investigation is needed with alcohol-using STI clinic patients to better understand the association between behavioral skills and unprotected sex with main partners.

Specifically, research considering potential moderators of the association between behavioral skills and sexual risk behavior is called for. One potential moderator of special relevance to the current population is alcohol consumption within sexual encounters. Behavioral disinhibition from alcohol use could be stronger in sexual encounters with primary partners compared to non-primary partners, moderating the effect between HIV prevention self-efficacy and unprotected sex worthy of additional investigation.

The inhibitory cues of higher self-efficacy could be stronger for sexual encounters with non-primary partners regardless of alcohol use, but perceptions of higher self-efficacy could be misinterpreted as confidence in a low-risk unprotected sex event with their primary partner potentially caused by alcohol-related behavioral disinhibition.

Kiene et al. Based on our own findings, we suggest future research to determine whether this moderating effect differs based on partnership type. Specifically, past studies found that information does not always have a direct effect on sexual risk behavior, but many studies suggest that information remains a necessary component of HIV prevention interventions because of the influence knowledge has on behavioral skills.

It has been argued that the importance of HIV prevention information may be attenuated within populations with higher levels of knowledge [ 37 ], and we found low levels of HIV prevention knowledge within this sample of alcohol-using STI clinic patients providing additional evidence in support of this hypothesis. The effects of motivation and behavioral skills within our models also provide evidence consistent with many IMB studies, but conflict with others.

This partial mediation effect of motivation on sexual risk behavior through behavioral skills is consistent with other IMB model research [ 21 , 25 , 27 — 29 , 31 , 35 , 44 , 56 ], but conflicts with evidence of a fully-mediating effect [ 32 , 36 , 43 , 49 ].

Our model adds to existing literature suggesting that the IMB model is to be tested within specific populations before planning intervention activities [ 14 , 16 ]. This theory-based research with alcohol-using STI clinic patients may aid researchers and practitioners in adapting and developing further intervention strategies to help this vulnerable population reduce their risk for subsequent STIs including HIV.

Although prior research has provided ample support of the IMB model, no previous studies have tested the model with this specific high-risk population. This research allowed us to identify a discrepant finding from other high-risk groups—mainly a difference in how behavioral skills operated based on partnership type.

This suggests that interventions targeting self-efficacy for HIV prevention behaviors for patients with primary partners may not be adequate to reduce unprotected sexual behaviors. Instead, additional emphasis should be placed on knowledge, motivation, and potential factors moderating the association between behavioral skills and unprotected sex. In summary, this research prompts additional research into the moderating effects of sexual partnership type between IMB model factors and sexual risk behavior, particularly related to HIV prevention self-efficacy.

First, the cross-sectional nature of this study limits our ability to substantiate any causal effects or rule out any equivalent models, but the findings of our study help support existing evidence published to date.

From a practical standpoint, behavioural principles can be used to design interventions that have the potential to incrementally shape behaviour at each level of influence i. Meichenbaum and Turk 42 suggested that four interdependent factors operate on adherence behaviour and that a deficit in any one contributes to risk of nonadherence. Chapter VII - Asthma. Although this approach has been shown to influence satisfaction with medical care, convincing data about its positive effects on compliance are scarce Self-regulation perspectives attempt to integrate environmental variables and the cognitive responses of individuals to health threats into the self-regulatory model 61, SOC tailoring may be a useful strategy for implementing complex, multi-component interventions in a cost-effective manner. The state-of-the-art measurement.

Information motivation behavioral skills model

Information motivation behavioral skills model

Information motivation behavioral skills model

Information motivation behavioral skills model

Information motivation behavioral skills model

Information motivation behavioral skills model.

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Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 18 June Published 12 January Volume Pages 75— Review by Single-blind. Peer reviewers approved by Dr Amy Norman.

Editor who approved publication: Dr Johnny Chen. The objective of this study was to examine whether the IMB model predicted medication adherence among vasculitis patients. A mediation analysis using a bootstrapping approach was used to test whether behavioral skills significantly mediated the effect of information and motivation on medication adherence.

Findings suggest that providers should work with vasculitis patients to increase their medication-related skills to improve medication adherence. Keywords: medication adherence, self-efficacy, vasculitis, information, information—motivation—behavioral skills model. Vasculitis is a rare disease that thickens, narrows, and scars the blood vessels. Therefore, a paucity of literature exists to assist public health researchers and physicians to increase their knowledge of modifiable behavioral skills that could be used to increase medication adherence behaviors among patients with vasculitis.

The information—motivation—behavioral skills IMB model of health behavior change is a theoretical model that was developed to predict HIV preventive behavior. However, the IMB constructs can be applied to multiple health promotion behaviors including medication adherence among different populations.

Although many behavioral-specific theories such as the Health Belief Model, 23 the Theory of Planned Behavior, 24 and the Transtheoretical Model 25 posit determinants of behavior that are amenable to change, the IMB model is the only model that includes adherence-specific information, motivation, and behavioral skills as needed for successful adherence among patients with vasculitis. The IMB model posits that an individual who is well informed, motivated, and has the requisite behavioral skills including a high level of self-efficacy will enact and maintain a health promotion behavior such as medication adherence.

Thus, medication adherence is defined as the result of the individual being informed about the treatment regimen, motivation to adhere to the regimen, and having the behavioral skills self-efficacy to adhere to the regimen in multiple contexts such as the work and home setting. The IMB model specifically posits that behavioral skills mediate the effects of information and motivation on medication adherence.

The objective of this paper is to examine whether information, motivation, and behavioral skills predict medication adherence for vasculitis patients. We specifically investigate whether information and motivation directly affect medication adherence or whether they are mediated via behavioral skills.

We also hypothesized that behavioral skills would significantly mediate the positive effects of information and motivation on patient medication adherence. Data for this analysis come from the Accessing Social Support in Symptom Treatment ASSIST study, which was a longitudinal study that assessed how social support and information seeking influenced patient medication adherence among patients diagnosed with vasculitis. Data collection was from June to February Carpenter et al describe these recruitment efforts in greater detail.

Participants completed two online questionnaires administered 3 months apart. Out of patients, patients were eligible for the study. A total of patients Of the participants who completed the baseline survey, only four did not complete the 3-month follow-up survey. Three were lost to follow-up and one experienced technical difficulties. Thus, resulting in a final sample of participants and a Participants who completed both questionnaires received a ten-dollar gift card. Written informed consent was obtained from all individual participants included in the study.

The baseline questionnaire assessed sociodemographic characteristics, disease status, and the information measure of the IMB model. The 3-month questionnaire assessed vasculitis medication adherence, motivation, and behavioral skills measures of the IMB model. Because the IMB questionnaire had not been used previously with a vasculitis patient population, we conducted five cognitive interviews with patients to assess the comprehension and relevance of the questionnaire items.

Cognitive interviews are defined as a technique that allows individuals to verbalize their opinions and feelings when examining information on a specific topic. We also conducted a confirmatory factor analysis with three factors and promax rotation to assess item loadings.

Six items were omitted for the following reasons: two informational scale items cross-loaded with the behavioral skills scale and one information scale item did not load on any factor, and two items on the behavioral skills scale cross-loaded on the information scale Table 1.

Abbreviation: SD, standard deviation. In this study, our final measure included six information items, six motivation items, and ten behavioral skills items. The information scale included items about possible side effects, how to take the medications, and what action to take if a dose is missed.

Behavioral items were reverse-scored so that higher values reflected higher levels of behavioral skills self-efficacy. Behavioral items included such items as managing side effects, storing medications properly, and refilling medications on time. Higher scores indicated greater levels of vasculitis knowledge, vasculitis skills, and motivation attitudes and beliefs of vasculitis management.

A summary score was created by averaging item responses and had a possible range of 0— The scale was comprised of seven items on a 5-point Likert scale. Higher scores indicated greater adherence.

Univariate analyses were conducted to characterize the sample and variables of interest. Pearson correlation bivariate analysis was used to examine the associations among study variables. A linear regression was conducted to examine the direct effects of information, motivation, and behavioral skills on vasculitis medication adherence. All analyses were conducted using Statistical Package for Social Sciences software, version A bootstrapping approach was used to run a mediation model to explore whether behavioral skills mediated the effects of information and motivation on medication adherence.

Multiple reasons are presented below as to why bootstrapping was conducted rather than causal steps to test for mediation. First, bootstrapping is a nonparametric test that does not impose the constraint of multivariate normality; therefore, it is robust for situations where data are skewed. Second, bootstrapping calculates an overall point estimate and confidence interval for each mediated indirect effect by generating a sampling distribution from 5, samples with replacement from the full data set reducing type I error rates.

Participants with missing data were omitted from the analysis. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation institutional and national and with the Helsinki Declaration of , as revised in A total of individuals with vasculitis participated in the study Table 1.

Table 2 presents the bivariate associations among study variables. The beta value of 0. None of the covariates were significantly related to medication adherence including attitudes and beliefs motivation. A mediation analysis was then conducted to assess whether the non-significant effects of information and motivation were mediated by behavioral skills.

Preacher and Hayes suggest that there are some circumstances in which an indirect mediation effect can occur without the presence of a significant direct effect. Table 3 Unstandardized beta B coefficients and P -values for linear regression predicting vasculitis medication adherence Notes: a One participant was excluded from the regression due to missing data.

Bold value represents a statistically significant result. Abbreviation: SE, standard error. Table 4 presents the summary of the mediation analysis for the direct and indirect effect of information and motivation on medication adherence with behavioral skills as the mediating variable. As shown in Figure 1 , an examination of indirect effects revealed that motivation and information were positively related to behavioral skills, and behavioral skills were significantly associated with higher medication adherence.

We examined whether the IMB model could be applied to explain medication adherence among patients living with a rare chronic disease. The authors hypothesized that higher levels of information, motivation, and behavioral skills would be significantly associated with higher vasculitis medication adherence among patients and that the effects of information and motivation on adherence would be mediated by increased behavioral skills.

After conducting a mediation analysis, we found support for the IMB-hypothesized relationships between information, motivation, behavioral skills, and medication adherence in our sample. These findings are similar with previous studies, which have also found that behavioral skills were associated with higher medication adherence among patients with an infectious disease 16 , 17 , 19 , 20 and that behavioral skills mediated the effects of information and motivation on medication adherence.

Although these findings highlight the importance of the IMB model for promoting medication adherence, additional research is needed to explain what types of information are important to vasculitis patients. If vasculitis patients are experiencing medication adherence issues then health care providers may want to directly address these issues by providing credible adherence-related information and verify that patients have the skills necessary to properly adhere, including having accurate knowledge of how to take medications and incorporate medication-taking in their daily schedules.

First motivation, behavioral skills, and medication adherence were all measured at the 3-month data collection time point, which limits our ability to truly test whether mediation occurred. Second, the study sample is a convenience sample which is not representative of the larger vasculitis population; thereby, limiting generalizability.

Fourth, the information, motivation, and behavioral skills measures were limited because of the removal of items, although all measures had an acceptable Cronbach alpha. The authors removed certain items from the LW-IMB-AAQ questionnaire because those items were not relevant to patients with vasculitis or performed poorly on factor analysis. Lastly, this sample does not demonstrate the direct effects of information and motivation on medication adherence that have been seen in previous research among patients living with HIV.

Poor medication adherence among vasculitis patients can result in morbidity, mortality, and high health care expenses. Our findings indicate that patients with higher levels of behavioral skills have better medication adherence. For this reason, providers may want to increase awareness of adverse events of medication non-adherence among vasculitis patients and propose practical strategies for increasing medication adherence.

For example, physicians could possibly teach patients how to incorporate their medication into their daily schedule, assist the patient in finding an accessible pharmacy within close proximity of their home environment, or having the patient repeat the medication directions and proper storage of the medication during the office visit, which are all specific behavioral skills that could lead to better medication adherence.

In addition, patients with negative attitudes and beliefs may benefit from a support group 38 , 39 to increase social support among vasculitis patients who may possibly feel alienated from family members and friends. In conclusion, we found support for the applicability of the IMB model in explaining medication adherence for vasculitis patients. IMB model-based efforts could include strategies for health care providers to assist patients in increasing their information, motivation, and behavioral skills to promote medication adherence.

Future studies should evaluate these efforts to demonstrate improvement in self-care behaviors including information quality to promote medication adherence among patients with vasculitis. American College of Rheumatology. Accessed August 22, Clinical and economic burden of antineutrophil cytoplasmic antibody-associated vasculitis in the United States.

J Rheumatol. Predictors of medication non-adherence for vasculitis patients. Clin Rheumatol. Cleveland Clinic. Center for Vasculitis Care and Research. Does adherence-related support from physicians and partners predict medication adherence for vasculitis patients?

J Behav Med. The effect of conflicting medication information and physician support on medication adherence for chronically ill patients.

Information motivation behavioral skills model