Predicting intention to use voluntary HIV counseling and testing services among health professionals in Jimma, Ethiopia, using the theory of planned behavior

Abstract

Background

To endorse involvement in voluntary HIV counseling and testing (VCT), it is essential to recognize factors that influence people in deciding whether to access VCT services and their underlying route factors. Theory of planned behavior (TPB) constitutes a proficient framework for predicting behaviors and intentions.

Objective

The aim of the study reported here was to assess the predicting ability of TPB in determining the intended use of VCT services among health professionals in Jimma, southwest Ethiopia.

Methods

This was an institution-based cross-sectional quantitative study of a sample of 336 health professionals in 12 selected districts of Jimma, southwest Ethiopia between February 5 to March 28, 2012. Data were collected using structured questionnaire self-administered by the study participants. A hierarchal multivariable linear regression model was used to predict the role of TPB constructs that can influence the intention to use VCT services.

Results

The constructs of TPB explained the variability in intention to use VCT by 27% (R² adjusted = 0.27). The standardized regression coefficients showed that the strongest predictor of intention to use VCT was subjective norms (β = 0.32, P < 0.0005) followed by attitude (β = 0.21, P < 0.002). Perceived behavioral control was not a significant predictor of intention to use VCT among the study group (P = 0.12).

Conclusion

The study revealed the possibility of describing the intention to use VCT among health professionals using TPB, with perceived social pressure being the leading predictor. In light of this, health intervention programs should be designed to develop health professionals’ ability to resist norms that oppose the use of VCT and to change community-held norms against VCT use, provided they help individuals develop a positive attitude toward the services.

Keywords:

• HIV/AIDS
• VCT
• health professionals
• intention
• TPB

Supplementary material

Measurement tools

Part I: sociodemographic characteristics

Table

Part II: direct TPB (theory of planned behavior) measurements

The following questions ask about your intentions, attitudes, social pressures, and your perceived difficulty of using VCT (voluntary HIV counseling and testing) services in the next 3 months. Encircle the number that best represents your choice according to your degree of agreement with the statement.

1. How likely is it that you will need HIV counseling and testing services in the next 3 months?

   1. Very unlikely

   2. Unlikely

   3. Neutral

   4. Likely

   5. Very likely

2. In the coming 3 months, how likely is it that you will be tested for HIV?

   1. Very unlikely

   2. Unlikely

   3. Neutral

   4. Likely

   5. Very likely

3. In the next 3 months, how likely is it that you will look for and request VCT services?

   1. Very unlikely

   2. Unlikely

   3. Neutral

   4. Likely

   5. Very likely

4. In the next 3 months, how likely is it that you will use VCT services?

   1. Very unlikely

   2. Unlikely

   3. Neutral

   4. Likely

   5. Very likely

5. Your receipt of VCT services in the 3 months will be (please give a separate answer for each question):

   Table

6. Most people who are important to you will approve of your using VCT services in the next 3 months.

   1. Strongly disagree

   2. Disagree

   3. Neutral

   4. Agree

   5. Strongly agree

7. Most people like you want to use VCT services in the next 3 months.

   1. Very unlikely

   2. Unlikely

   3. Neutral

   4. Likely

   5. Very likely

8. It is expected of you that you will use VCT services in the next 3 months.

   1. Strongly disagree

   2. Disagree

   3. Neutral

   4. Agree

   5. Strongly agree

9. Most people who are important to you think that you should use VCT services in the next 3 months.

   1. Strongly disagree

   2. Disagree

   3. Neutral

   4. Agree

   5. Strongly agree

10. For you to use VCT services in the next 3 months is (please give an answer for each question):

    Table

Part III: VCT status

1. Have you ever been tested for HIV/AIDS before?

   1. Yes

   2. No

2. If yes, when was the last time you used VCT services?

   1. Three months ago

   2. Six months ago

   3. Twelve months ago

   4. Other; please specify: ____________

3. How many times did you use VCT services?

   1. Once

   2. Twice

   3. Three or more times

4. Have you received post-test counseling and the test result?

   1. Yes

   2. No

5. If yes, why did you choose to receive the result? (More than one answer is possible.)

   1. Fear that I could be infected

   2. Fear that I was professionally at risk

   3. I want/wanted to donate blood/organs

   4. I had/have an unfaithful partner

   5. I want/wanted to get married

6. Where did you use VCT services? (More than one answer is possible.)

   1. Government health institution

   2. Private health institution

   3. Friendly health service institution

7. Who provided the VCT services to you?

   1. VCT counselor

   2. Self

   3. Other; please specify: __________

Operational definitions and measurements

Intention of having VCT

This referred to the individual’s plan to use HIV counseling and testing in the near future (next 3 months). Generalized intention was measured using four items (α = 0.89). Responses ranged from “not likely at all” (1) to “very likely” (5). A high total score/mean score indicated a high intention to use VCT and were used in the analysis.

Attitude toward the use of VCT

This meant an individual’s predisposition to respond in a favorable or unfavorable manner toward the use of VCT. This was measured using four items on bipolar differential scales (α = 0.92). A high total score indicated a highly favorable attitude.

Direct subjective VCT norms

This was an individual’s perception that significant others, in general, think that the individual uses VCT services as a normative action. Four items (α = 0.82) were used to measure this component in which respondents had to indicate their level of agreement with a statement on a scale from “Strongly disagree” to “Strongly agree.” Relatively low and high composite scores indicated negative social pressure (pressure against the behavior – ie, VCT utilization) and positive social pressure (pressure in favor of the behavior [VCT utilization]), respectively.

Direct measure of perceived behavioral control

This indicated an individual’s confidence about using VCT services in the next 3 months, if they desired to. This was measured using four items on bipolar differential scales (α = 0.91). High composite scores showed strong perceived ability or less difficulty in using VCT services within the specified period.

Past VCT service use

This component considered past VCT experience of health care professionals at least once in their lifetime. One item was used to ask respondents whether they had been tested for HIV in the past by indicating “Yes” or “No” as appropriate.

Authors’ contributions

All authors contributed equally in planning and organizing the study, analyzing the data, developing the manuscript, reviewing and approving the final manuscript for publication.

Disclosure

The authors declare no conflicts of interest in this work.