The role of self-efficacy to explain the effect of counseling time on changes in risky sexual behavior among people living with HIV: a mediation analysis

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  • March 22, 2019
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  • Chariyeva, Zulfiya
    • Affiliation: College of Arts and Sciences, Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Little is known about the amount of motivational interviewing (MI) counseling time needed to reduce risky sexual behavior among people living with HIV/AIDS (PLWHA) or the roles that self-efficacy and motivation to practice safer sex play in the relationship between MI time and sexual risk behavior. In Study 1, I used hierarchical linear regression models to examine the impact that the amount of MI counseling patients received had on their self-efficacy to practice safer sex. Analyzing data collected in 4 month intervals from a cohort of 490 PLWHA for 12 months (number of observations=1577), I found that patients who received more MI time and a greater number of MI sessions had greater self-efficacy. In Study 2 hierarchical negative binomial regression was used to examine the association between MI time and sexual risk behavior. I conducted a mediation analysis to evaluate the extent to which changes in self-efficacy and motivation explained the association between predictors and outcome. I conducted analyses from a cohort of 183 PLWHA (number of observations=600) who received safer sex MI at several points over 12 months. I found that as the MI time and number of provided sessions increased over time, participants' sexual risk behavior decreased. I concluded that the effect of counseling time and number of counseling sessions on sexual risk behavior was mediated by self-efficacy to practice safer sex. On the other hand, motivation to practice safer sex did not mediate the relationship, although I documented a statistically significant positive association between motivation and safer sexual behavior. These findings suggest that the amount of time spent in MI, whether measured in number of sessions or number of minutes, is an important factor for enhancing safer sex self-efficacy and safer sexual practices among PLWHA. Counseling time has its effect on sexual behavior in part via changes in self-efficacy. My research suggests that MI based prevention programs for PLWHA need to enhance self-efficacy to practice safer sex in order to ensure a behavior change. My findings provide evidence that more time spent counseling PLWHA can have a positive impact on patient and public health outcomes.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Gillings School of Global Public Health (Department of Health Behavior and Health Education).
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  • Golin, Carol E.
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