Applicability of the Theory of Planned Behavior to explain clinicians’ intention to screen men who have sex with men for syphilis infection

Abstract

Syphilis prevention in the United States continues to be an enduring public health challenge. Although syphilis is a curable infection, if left untreated it can result in severe, debilitating and potentially life-threatening complications. Routine screening for syphilis in high-risk populations remains an important prevention and control measure. Research consistently demonstrates the relative advantage of greater testing frequency in at-risk populations such as men who have sex with men (MSM) using both cost-effectiveness analyses and mathematical modeling. Despite this, frequency of screening for syphilis among MSM remains sub-optimal, and failure to screen MSM at recommended intervals may be attributable to clinicians’ perceptions related to syphilis screening in this population. The Theory of Planned Behavior (TPB) may help to elucidate the attitudes, social and professional norms, and perceived behavioral control that providers experience towards syphilis screening. The extent to which these cognitive-behavioral factors facilitate clinicians’ intentions to screening MSM for syphilis has not been previously evaluated. Using the constructs of the TPB, this study developed and validated a new survey tool with a national sample of physicians (n=123) who treat MSM and recruited through a proprietary email list and through passive recruitment on social media and provider Listservs. Results of the survey revealed variability in providers’ attitudes, social norms and perceived behavioral control, and these differed in association with self-reported syphilis screening intention and behavior. The survey was also used to validate a measurement model based on the TPB. This measurement model consisted of four factors: attitudes, social norms, perceived behavioral control and intention. This model was then used in structural equation modeling analysis to simultaneously test the strength of associations between these factors and a self-reported behavioral outcome. Results indicate that attitudes have a significant indirect effect on self-reported screening behavior mediated though intention. Perceived behavioral control was also strongly associated with self-reported behavior, as was intention to screen. By incorporating the TPB into a model of physician behavior, this study provides a framework for interventions targeted at increasing syphilis testing frequency in clinical practice.