Skip to main content

Table 1 Summary of intervention theories of change

From: Theories of change for e-health interventions targeting HIV/STIs and sexual risk, substance use and mental ill health amongst men who have sex with men: systematic review and synthesis

Intervention name Technology Reports Summary of theory of change including key constructs and mechanisms How theory of change was developed Existing theories drawn on Evidence supporting the theory of change
China – Gate HIV Prevention Programme Online Intervention Internet Cheng [59] Informed by the theory of planned behaviour, the intervention targeted attitudes, subjective norms, perceived control and behavioural intentions which are posited as key determinants of health behaviours. It aimed to increase knowledge and reduce misconceptions. Part I aimed to engage participants and increase HIV risk perceptions by presenting realistic scenarios and to increase awareness of community norms by presenting peer attitudes towards behavioural decisions. Part II addressed basic HIV/AIDS knowledge and transmission; presented information about the HIV epidemic amongst MSM, aiming to further increase perceptions of consequences of CAS and to promote safer sex and addressed misconceptions about sexual behaviours. Not stated Theory of planned behaviour Not stated
Cognitive Vaccine Approach
(tailored and non-tailored versions)
Internet Davidovich [70] There were two versions of this online cognitive behavioural intervention promoting negotiated safety (i.e. condomless anal intercourse between steady partners who are both HIV-negative). A non-tailored version delivered all modules, and a tailored version delivered general content considered relevant for all users in addition to selected modules considered relevant to the user based on a baseline questionnaire assessing their barriers to safe sex. Each module targeted specific cognitive determinants of behaviour. Informed by the IMB model, modules addressed information, motivation and behavioural skills; the motivation component was further informed by other behaviour change theories. The intervention did not focus on promoting condom use but did provide information on condoms and recommended their use where negotiated safety was not feasible.
Information modules addressed how to practice-negotiated safety, aiming to increase response efficacy (comprising knowledge of and belief in benefits of this approach for protecting against HIV). Informed by the theory of planned behaviour, motivation modules aimed to correct faulty beliefs in order to shape attitudes and informed by the health belief model, motivation modules aimed to increase users’ perceptions of HIV testing benefits as well as users’ sense of vulnerability to contracting HIV from steady partners. In turn, attitudes were theorised to increase condom use intentions and attitudes, sense of vulnerability and perceived benefits of HIV testing were theorised to increase intentions to practice negotiated safety (comprising its three components of HIV testing, reaching agreements about sex outside of the relationship and warning the partner if sexual risk outside of the relationship occurred).
Modules were guided by the IMB model and content was informed by empirical research. IMB model, operationalising the ‘motivation’ component by drawing on components of the theory of planned behaviour and the health belief model Content was based on past research on determinants of sexual risk behaviour in steady relationships. Authors highlighted that the IMB model has been effective in promoting HIV prevention behaviours amongst various groups, including amongst gay men.
Gay Cruise Internet Kok [73] In this online interactive simulated cruise ship, users (MISM) selected a virtual character to guide them through the intervention using scripted, tailored dialogue. This guide introduced strategies to promote consistent condom use by making condom use an automatic behaviour. The intervention addressed knowledge (about dating, sex and safer sex) via active learning; risk perceptions via consciousness raising and feedback; skills via instruction (including video instruction), feedback and reinforcement; self-efficacy via this skill-building and via modelling, reinforcement and building on the learner’s perspective; and access to condoms via addressing where to buy condoms and offering a sample package. The intervention also aimed to influence attitudes about condoms, personal and subjective norms and anticipated regret.
Intermediate outcomes included the following: making the decision to use condoms, purchasing condoms and lubricant, negotiating condom use during online chatting, expressing the wish to use condoms in the user’s chat profile, carrying enough condoms and lubricant when on a date, correctly using condoms and lubricant and using condoms consistently even in difficult circumstances.
At part of the systematic ‘intervention mapping’ process for intervention development, researchers searched the literature for behaviour change methods that could address programme objectives; drew on existing theory; and, in consultation with experts in MSM, chatting, e-dating and the Internet, selected theoretically informed strategies to achieve programme objectives. Transtheoretical model and social cognitive theory Not stated
HealthMindr Smartphone/ mobile app Sullivan [84]
Jones [66]
Features of this mobile app included the following: risk assessments used to provide tailored prevention suggestions, with customisable assessment reminders; screeners assessing eligibility for PrEP and PEP; tailored recommendations for HIV testing frequency; identification of HIV testing options tailored to participant preferences and testing location details and map; an HIV test planner with customisable reminders; test kit, condom and lubricant ordering; substance use/mental health screening; service directory and a feature allowing users to submit questions to study staff. Based on social cognitive theory, risk assessments are theorised to lead to feedback and self-regulation, and for each of several targeted health behaviours app features were designed to promote four mechanisms of change: goal-setting, self-efficacy, outcome expectations and self-regulation. Amongst the targeted health behaviours were making an HIV testing plan, using condoms, self-screening for PrEP, and—for those living with HIV—seeking HIV care. The authors described the theory of change for the behaviour of HIV testing as an example: The ‘Make a plan’ feature promoted goal-setting; presenting information and several testing options promoted self-efficacy; information about the benefits of testing promoted positive outcome expectations; and a customizable reminder system for testing promoted self-regulation. Not stated Social cognitive theory Not stated
Hot and Safe M4M
(website name)
Internet Carpenter [68] Based on the IMB model, this module-based intervention aimed to reduce risk of HIV and other STIs by addressing information, motivation and behavioural skills. The information component aimed to increase knowledge of risk factors. Intervention activities assessed readiness to change and incorporated stage-based and (informed by motivational interviewing approaches) decisional balance exercises to increase motivation. Informed by motivational interviewing, the intervention also assessed HIV risk factors and targeted feedback based on user responses, and identified perceived barriers to change in order to increase self-efficacy for change. Skills training addressed skills for safer behaviour; topics addressed in communication skills training included communication about HIV status, condom use negotiation, sexual rights, differences in communication styles and sexual safety contracts. Not stated IMB model and motivational interviewing Authors cited references for IMB model as an effective approach for HIV prevention.
Internet-Based Safer Sex Intervention
(no name)
Internet Milam [76] This intervention aimed to reduce STI and HIV transmission by targeting the following behaviours amongst HIV-positive MSM: condom use, disclosure to sex partners, ART initiation and reduced use of drugs and alcohol. Based on their responses to monthly sexual behaviour surveys, users were directed to static web pages tailored to their risk of STI and HIV transmission. Informed by social cognitive theory and the transtheoretical model, the intervention used messaging that took into account the user’s current behaviour and intent related to the targeted behaviour change. Not stated Social cognitive theory and the transtheoretical model Not stated
Keep it Up! Internet Mustanski [77]
Greene [71]
Mustanski [79]
Mustanski [80]
Madkins [64]
Participants were recruited to this online modular HIV prevention intervention following a negative HIV test, a time when they were believed to be particularly receptive to HIV prevention efforts. Informed by the IMB model, intervention activities were theorised to engender knowledge, motivation and behavioural skills and self-efficacy. In the model, self-efficacy comprised both confidence in enacting safer sex behaviours such as condom use and discussing safer sex with a sex partner, and the ability to avoid condomless anal intercourse when condoms were not available or when facing pressure from a partner. Activities involving reflection were theorised to impact behavioural intentions, an examination of safer sex practices (e.g. pros and cons of condom use), perceived social norms (amongst partners, friends and family) and a sense of vulnerability which, along with identifying sources of support, were theorised to contribute to motivation. Booster sessions were designed to reinforce learning and provide additional information on HIV prevention. Not stated IMB model Not stated
MOTIVES Text messaging Linnemayr [74] This text message-based HIV prevention intervention aimed to provide prevention information and to have participants engage with and retain it, increase HIV-testing frequency and support users in staying HIV-negative. Weekly, the user received a text message providing HIV prevention information. Informed by behavioural economics, which suggests that ‘nudges’ can be effective in changing behaviours, a follow-up text message 2 days later asked the user a question about the information received and told them that a correct answer would increase their chance of winning a prize. The ‘nudge’ of an opportunity to win a prize was theorised to incentivise ongoing engagement with the intervention, increasing knowledge retention to supporting behaviour change. Informed by behavioural economics research suggesting that prompt and frequent feedback is important for behaviour change and can help keep users engaged, users received a message immediately after sending their response that indicated whether they were correct and provided a link with more information. If they were correct, the messages also told them they had increased their chances of winning the next prize drawing. Informed by principles of behavioural economics, the intervention provided frequent prizes in order to increase salience, which the authors theorised kept the desired behaviour high on the user’s list of priorities. Users also received a text message reminder every 2.5 months to test for HIV. The intervention also aimed to increase self-efficacy as a mediator of behaviour change.
The theory underpinning this intervention also accounted for variation depending on participant characteristics, identifying socio-demographics, acculturation, mental health and substance abuse as potential moderators of its impact.
Not reported Behavioural economics Studies suggest that lotteries can be effective in influencing a range of health behaviours, including sexual behaviour, and there are promising early results from a study aiming to improve antiretroviral adherence using this approach. Other studies suggest that behavioural economics approaches of delivering feedback promptly and frequently can support engagement and is important for behaviour change.
myDEx Internet Bauermeister [55]
Bauermeister [60]
This online module-based comprehensive sex education intervention aimed to improve psychological well-being and reduce HIV risk via behaviour change (increasing condom use, increasing HIV/STI testing and reducing unprotected anal sex), increasing PrEP awareness/uptake/adherence and decreasing alcohol and drug use before sex. It was informed by the notion that decision-making is shaped by both affective and cognitive motivations, that affective motivations can be processed more quickly and therefore might drive decision-making and that when cognitive and affective motivations are less aligned, there is less of a correspondence between intentions and behaviour. The intervention therefore aimed to increase users’ cognitive motivations and to influence affective motivations. Content included information provision, activities and videos and via the latter two also aimed to build HIV risk reduction skills and promote self-reflection.
Content targeting cognitive motivations focused on risk reduction attitudes (comprising attitudes towards consistent condom use, status disclosure and HIV/STI testing), risk reduction norms (comprising subjective norms, personal norms such as anticipated regret and descriptive norms, i.e. perceived prevalence of behaviours within one’s social group) and perceived behavioural control to engage in risk reduction behaviours (i.e. the ability to elicit/disclose HIV status, negotiate condom use and delay sexual intercourse). Attitudes and norms were theorised to each influence each other, and all three constructs were theorised to influence behavioural intentions.
Acknowledging the influence of affective motivations on behavioural intentions, the intervention also addressed relationship ideation, anticipated regret, limerence and decisional balance to forego condoms. Behavioural intentions were theorised, in turn to directly influence HIV risk reduction behaviours.
The theory underpinning this intervention also accounted for variation depending on participant characteristics: psychological risk correlates, which include sexuality-related stressors (e.g. internalised homophobia), psychological distress (e.g. depression, anxiety, loneliness and low self-esteem) and substance use and abuse were theorised to influence regulation of affective motivations and therefore behavioural control, affecting risk behaviours. Type of sexual partner (e.g. casual encounter, romantic interest or friend with benefits) was theorised to affect perceived behavioural control and the relationship between behavioural intentions and actual behaviours.
Not stated Dual processing cognitive-emotional decision-making framework; and the IMB model Research suggests decision-making can be affectively rather than analytically driven because affective motivations might be processed more quickly than cognitive motivations. The authors also noted that intentions correspond less with behaviour when affective and cognitive motivations conflict; and that anticipation of an emotional reaction following an unintentional behaviour is associated with less risk-taking amongst MSM.
MyPEEPs Mobile Internet Kuhns [88] Delivered via games, scenarios and role-plays in 4 sequential modules, this app aims to reduce sexual HIV risk and promote health behaviours amongst adolescent sexual minority men. Content delivers information on HIV/STIs amongst YMSM, promotes skill-building (for condom use, emotional regulation and negotiating interpersonal and substance-related risks) and aims to raise awareness about minority stress. A goal-setting activity running throughout the intervention aims to build knowledge, self-awareness and self-efficacy by asking participants to establish and regularly reconsider their limits and the risk they are willing to accept for different types of sexual acts. The authors also state that content addresses psychosocial and contextual factors important to young people’s vulnerability to risk, including affect dysregulation (psychosocial) and family, peer and partner relationships (contextual). Not stated Social-personal framework, which authors say builds on social learning theory Intervention is based on a group-based intervention that was effective in reducing sexual risk behaviour.
Online Mindfulness-Based Cognitive Therapy
(no name)
Internet Avellar [58] Though the target population was not restricted to those who have experienced bullying, the rationale supporting the intervention posited that anti-LGBQ bullying could lead to internalised homophobia (also referred to as internalised homonegativity), which could cause self-stigma, undermine self-worth and cause avoidance of emotions, thoughts and situations. In this online modular intervention, sessions 1-4 focused on teaching users to identify and understand emotional and cognitive patterns causing distress and sessions 5-8 taught users how to handle these and their effect on mood, i.e. skills for awareness, moving attention to breathing, then expanding this attention to the whole body. Via practices such as increasing awareness of ingrained routines, paying attention to and accepting sensations/feelings/thoughts in each moment without judgement, developing a third-person awareness and prioritising ‘being’ over ‘doing’ or goal-attainment, and by developing an understanding of the relationship between thoughts and moods, the intervention aimed to develop skills for reducing rumination about unpleasant experiences, reducing the time that unpleasant thoughts stay in the mind, and alleviating unpleasant thoughts, feelings and emotions. Via these skills and by reducing internalised homophobia, the intervention aimed to reduce the recurrence of depression and to improve mental health. Intervention was modelled on an existing 8-week mindfulness-based cognitive therapy protocol found to be effective for addressing symptoms of depression and anxiety. Mindfulness-based cognitive therapy combines mindfulness and cognitive behavioural techniques to alleviate depressive symptoms A 2012 study found that Acceptance Commitment Therapy, of which mindfulness was a key mechanism, was effective in improving outcomes including internalised homonegativity, depression, anxiety and stress amongst LGBQ participants experiencing self-stigma related to their sexual orientation. Furthermore, the Online Mindfulness-Based Cognitive Therapy intervention was modelled on an existing protocol effective for addressing symptoms of depression and anxiety.
People Like Us Internet Tan [65] Sexual health messages incorporated into this web drama series aimed to increase HIV/STI knowledge and risk perception; provide information on HIV/STI testing and its benefits as well as resources for HIV/STI testing and other mental health services; address homophobia and sexual identity disclosure; increase self-efficacy for negotiating safer sex and promote positive attitudes, skills and self-efficacy related to safer sex. Content incorporated modelling of safer sex behaviours. The intervention aimed to impact perceived homophobia; internalised homophobia; self-concealment of sexual orientation; connectedness to the LGBT community; HIV knowledge; HIV/STI risk perceptions; consistent condom use; STI incidence and HIV/STI testing intentions, behaviours, self-efficacy and social norms. Not stated Not stated Not stated
Queer Sex Ed Internet Mustanski [78] This comprehensive sexual health curriculum for LGBT youth, delivered via online modules, was guided by the IMB model. The IMB model posits that health behaviours result from information, motivation and behavioural skills. The authors highlighted motivation as particularly important for adolescents and posited that motivation consisted of perceived vulnerability to health problems, as well as attitudes, intentions and perceived social norms. The intervention also aimed to influence sexual health behaviours by increasing self-efficacy (specified in relation to coming out and to creating and adhering to sexual agreements); a sense of connectedness to and belonging in the LGBT community; knowledge; and behavioural skills. Specific targeted outcomes mapped on to the topics of the first 4 intervention modules (NB, outcomes were not assessed for the 5th module, addressing goal-setting) and included sexual identity, sex education, healthy relationships and safer sex. Intervention was informed by prior mixed-methods research. IMB model None stated
Rainbow SPARX Computer (CD-ROM), with paper-based user notebook Lucassen [75] Rainbow SPARX, a computerised CBT programme designed as a computer game, introduced six core CBT skills which were theorised to support users in addressing harmful core beliefs that affect mental health. The main CBT skills covered in the intervention were the following: relax (relaxation training); do it (e.g. behavioural training); sort it (e.g. social skills training); spot it (recognising or naming cognitive distortions); solve it (problem solving) and swap it (e.g. cognitive restructuring). Content tailored to issues and experiences of sexual minority youth targeted particular challenges facing this population such as internalised homophobia and exposure to negative attitudes about same-sex attraction. Author descriptions suggested that the intervention was theorised to work via behavioural and relaxation training and via teaching users to recognise and challenge cognitive distortions. Each user could customise their avatar using any of the customisable options regardless of whether the options were traditionally female or male, with the rationale that negative repercussions often faced by this population for non-gender-conforming behaviours could contribute to internalised negative attitudes about behaviours that were natural for these young people. The general approach of CBT was adapted to address challenges sexual minority young people face. CBT theory Authors cited evidence that CBT is effective in treating depression amongst adolescents.
Role-Playing Game Computer download Coulter [62] This role-playing game aimed to improve health of bullied sexual and gender minority youth by improving help-seeking and productive coping strategies to reduce substance use, victimisation and mental health issues. The user played a customisable character who builds a team with nonplayble characters in order to defeat robots in the Holochamber Challenge. The user was tasked with helping each nonplayable character with challenges such as bullying, confidence or anger, and if successful that character joined their team. Elements of social cognitive theory, stress and coping theory and the social and emotional learning framework were embedded in the game.
Pairing the player with lonely characters was theorised to increase help-seeking intentions, self-efficacy and behaviours. Active listening and helping another character overcome were theorised to increase productive coping strategies (assessed as problem solving coping) and coping flexibility (assessed as ‘evaluative coping,’ or how well the user monitors and evaluates the outcomes of coping, and ‘adaptive coping,’ or how well the user uses an alternative coping strategy to achieve a desired outcome). Collating information about bullying and external resources was theorised to increase knowledge and use of Web-based resources. The intervention also aimed to decrease non-productive coping (assessed as passive avoidant coping).
Drawing on social cognitive theory, the authors suggested that self-efficacy and social skills could be developed via behavioural rehearsal, witnessing outcomes of one’s choices and feedback. Whilst not linked directly to intervention components in the authors’ narrative, these techniques were embedded in intervention design, which included supporting nonplayable characters in productive coping (rehearsal); receiving reports on the outcomes for each character based on the user’s decisions (witnessing outcomes) and receiving hints about how to better help other characters where appropriate (feedback).
Loneliness, internalised gender minority stigma and internalised sexual minority stigma were also assessed, although their relationships to other outcomes were not specified.
Not stated Social cognitive theory, stress and coping theory and the social and emotional learning framework Not stated
Safe Behaviour and Screening Smartphone/ mobile app Chiou [61] The app drew on the IMB model, which posits that information, behavioural motivation and skills influence HIV prevention behaviour. App content provided information which aimed to increase knowledge. Survey measures suggest the intervention also targeted motivation (comprised of attitude towards reducing risky sexual behaviour and recreational drug use, and intention to change these behaviours) and behavioural skills for HIV prevention (including partner communication, negotiating safe sex, drug and unsafe sex refusal skills and correct condom use). Not stated IMB model Not stated
Sex Positive! Internet Hirshfield [72]
Hirshfield [63]
Informed by social cognitive theory and social learning theory, this intervention aimed to prevent onward HIV transmission amongst MSM living with HIV. Following the character “Guy,” a gay man living with HIV, a 6-video dramatic series sought to optimise engagement by featuring stories and characters with which target users would identify. Content focused on HIV transmission, and informed by social learning theory (which posits that people learn by observing others’ attitudes and behaviours and the outcomes of their behaviours), it used modelling to demonstrate risk reduction and health behaviours including HIV disclosure, medication adherence and discussions about safer sex. Content aimed to promote critical thinking about medication adherence, viral suppression, HIV disclosure, sexual decision-making under the influence of drugs or alcohol and serodiscordant CAS. Via modelling the videos also depict cognitive dissonance and expectation failure. Authors’ description of social learning and social cognitive theories combined with the constructs assessed in user surveys suggested critical thinking was theorised to promote self-efficacy for safer sex and for HIV status disclosure to the user’s partners; promote perceived personal and partner responsibility for preventing HIV transmission; and shape outcome expectancies for condoms, anal sex and HIV disclosure. The report also suggested that modelling of self-regulation aimed to improve skills for regulating sexual compulsivity. Taken together, these mediators were theorised to influence HIV treatment adherence, mental health, substance use, sexual behaviour and interpersonal violence outcomes. Four follow-up booster videos aimed to help sustain intervention impact over time. Not stated Social cognitive theory and social learning theory; authors also noted that elements of both social learning and attitude change theories informed the intervention Not stated
Sexpulse Internet Rosser [82]
Wilkerson [86]
This modular HIV prevention intervention was guided by the sexual health model, which posits that people are more likely to make decisions that are sexually healthy when they themselves are sexually healthy. The intervention addressed the following aspects of the model: (1) mental and emotional health, (2) physical health, (3) intimacy, (4) relationships, (5) sexuality and (6) spirituality. Content covered other specified topics as body image and communication, amongst others, but their relationship to the sexual health model and to the intervention was not clear. Based on the authors’ description, the theory of change underpinning the intervention seemed to be that addressing aspects of broader sexual health would support safer sexual health decision-making. Not stated Sexual health model Not stated
Smartphone Self-Monitoring
(no name)
Smartphone/ mobile app Swendeman [85] In this smartphone-based intervention, customisable alarms prompted the user to fill in self-monitoring surveys and participants could access a Web-based visualisation tool to view their survey responses over time and by location as well as associations between variables. Daily surveys asked about alcohol, tobacco and other drug use; sexual behaviours; and medication adherence. Surveys 4 times per day asked about physical and mental health. The intervention also included event-based reporting about stressful events, and text diary entries, both of which could be done at any time.
Self-monitoring was theorised to support self-management via the user’s response to feedback deriving from self-observation. Whilst authors highlighted that mechanisms of self-monitoring interventions are not well-understood, their description suggested that processes such as the user reflecting on their behaviours in comparison with particular criteria (e.g. perceived norms or personal standards) could lead to reinforcement via self-reward or self-critique, resulting in self-regulation and ultimately self-management in four domains of HIV-related health outcomes: medication adherence, mental health, substance use and sexual risk behaviours.
Not stated Underpinned by the notion that self-monitoring can support self-management; NB, we note that self-monitoring is a core construct of social cognitive theory [89] In studies of alcohol, tobacco and drug abuse and sexual risk reduction HIV interventions, changes amongst control groups suggest self-monitoring (via assessments) can effectively improve targeted outcomes. Evidence suggests self-monitoring is a key component of evidence-based interventions for a range of conditions, and some evidence from meta-analyses suggests self-monitoring can be particularly effective for changing and maintaining behaviours.
SOLVE (Socially optimised learning in virtual environments) Computer download Christensen [69] In this 3-D animated game, the user took the role of a customisable avatar and made decisions which affected the narrative in simulated settings presenting risky situations and barriers to safer sex that young adult MSM typically confront on first dates or ‘hook-ups’. Via multiple theorised pathways, the intervention aimed to decrease condomless anal intercourse thereby reducing HIV risk.
Informed by the notion that shame due to ‘sexual stigma’ can contribute to HIV risk behaviours, the intervention simulated shame-inducing situations; promoted conscious acknowledgement and normalisation of the user’s desires; and role-modelled positive attitudes towards one’s self as well as comfort with the user’s sexuality and desires. Guide characters and sex partners within the game were accepting of the user’s desires and also shared them. Whilst the relationship between specific aspects of the intervention and theorised mechanisms was not explicit, the authors’ description suggested these features of the intervention aimed to decrease shame by normalising the MSMs’ desires, increasing self-worth and self-acceptance and reducing isolation and feelings of inferiority.
Additionally, drawing on neuroscience research suggesting that emotions play a critical role in decision-making, SOLVE aimed to increase self-awareness of goals, emotions and barriers to safer sex; promote recognition of the consequences of the user’s desires; interrupt affect-based decision-making and increase self-regulation. Authors’ descriptions seemed to suggest these were accomplished by challenging user choices and exploring their consequences within the simulated scenarios. Other components of the intervention aimed to increase HIV knowledge and hone HIV risk-reduction skills and strategies.
Not stated Theory of planned behaviour, social cognitive theory and neuroscience research suggesting that emotions play a critical role in decision-making Two prior RCTs of similar interventions were effective in reducing unprotected anal intercourse.
TXT-Auto Text messaging Reback [81] TXT-Auto aimed to reduce substance use and HIV risk amongst out-of-treatment methamphetamine-using MSM. Users received 5 automated scripted text messages per day, which included both general messages and messages tailored to the user’s risk profile. Risk profile was determined based on responses to a baseline survey assessing risks in relation to HIV status, ART adherence, drug use and sexual behaviours. Text message content was based on social support theory, social cognitive theory and the health belief model, which the authors described as complementary theories, though the constructs drawn from each theory and the intended mechanisms of change were not described. Text messages aimed to increase knowledge, and an example provided of messaging informed by social cognitive theory suggested they might also aim to increase self-efficacy. A brief weekly text-based assessment asking about methamphetamine use and HIV sexual behaviours in the past 7 days aimed to increase self-monitoring. Taken together, intervention activities aimed to decrease methamphetamine use, sex during methamphetamine use and CAS. The theoretical constructs underpinning the intervention were selected during a pilot study, informed by evidence-based behavioural change theories with complementary designs. Text messages were based on social support theory, social cognitive theory and the health belief model Authors note that theoretical principles on which each behavioural change theory rests have been proven effective in multiple studies.
WRAPP Internet Bowen [67]
Bowen [56]
Williams [87]
Schonnesson [83]
WRAPP was informed by social cognitive theory and the IMB model, and each of its three modules corresponded to one aspect of the IMB model. The ‘knowledge’ module was designed as the ‘information’ component and primarily addressed living with HIV and HIV prevention, aiming to increase HIV knowledge. The ‘partner’ module aimed to increase motivation (comprising outcome expectancies for risk reduction and willingness to reduce HIV risk behaviours). It addressed risk with both new and casual partners, supporting participants in clarifying long-term life goals and in considering whether these were consistent with unsafe sex. The ‘contexts of risk’ module targeted behavioural skills, supporting the user in adopting risk reduction behaviours with sexual partners met online or in a bar.
Knowledge, motivation and behavioural skills were theorised to increase sexual self-efficacy (comprising mechanical self-efficacy—such as self-efficacy for correct condom use—and self-efficacy to refuse CAS), which was theorised to be a direct precursor of behaviour change.
Not stated Social cognitive theory and the IMB model Evidence was not discussed directly, but in a later iteration [56] the authors noted that their work extended an earlier iteration that improved HIV-related knowledge, condom use outcome expectancies and condom use self-efficacy.
  1. AIDS acquired immunodeficiency syndrome, ART antiretroviral therapy, CAS condomless anal sex, CBT cognitive behavioural therapy, HIV human immunodeficiency virus, IMB model information-motivation-behavioural skills model, LGBQ lesbian, gay, bisexual and queer, LGBT lesbian, gay, bisexual and transgender, MISM men who use the internet to seek sex with men, MSM men who have sex with men, PEP postexposure prophylaxis, PrEP pre-exposure prophylaxis, RCT randomised controlled trial, STI sexually transmitted infection, YMSM young men who have sex with men