Mpox prevention self-efficacy and associated factors among men who have sex with men in China: a large cross-sectional survey (Preprint)

Abstract

BACKGROUND Self-efficacy in mpox prevention plays a pivotal role in promoting preventive behaviors by fostering a sense of control and motivation, especially among men who have sex with men (MSM), the population most affected by mpox in many countries. OBJECTIVE This study aims to assess the mpox prevention self-efficacy among MSM in China and identify factors influencing it, using a validated Mpox Prevention Self-Efficacy Scale. METHODS From November 2023 to March 2024, a nationwide cross-sectional study was conducted across six geographic regions in China using a snowball sampling method. The Mpox Prevention Self-Efficacy Scale was assessed for reliability and validity. Univariate and multivariate logistic regression were employed to examine factors associated with mpox prevention self-efficacy among MSM. RESULTS Among the 2,403 participants, the median mpox prevention self-efficacy score was 23.00 (IQR = 5.00). The Mpox Prevention Self-Efficacy Scale demonstrated good internal consistency (α > 0.80) and a strong model fit (χ² (N = 1,225; DF = 5) = 32.080, P < 0.0001; CFI = 0.992; RMSEA = 0.067; SRMR = 0.02). Logistic regression analysis indicated that mpox prevention self-efficacy was significantly associated with mpox-related knowledge (OR 1.107, 95% CI 1.070–1.146), perceived risk awareness (OR 1.338, 95% CI 1.132–1.583), and mpox risk perception (OR 1.154, 95% CI 1.066–1.250). Individuals over 25 years old exhibited lower self-efficacy in mpox prevention (25–34 years: OR = 0.789, 95% CI 0.642–0.970; 35–44 years: OR = 0.572, 95% CI 0.444–0.736; 45 years and older: OR = 0.569, 95% CI 0.394–0.823). CONCLUSIONS These findings underscore the importance of targeted interventions aimed at enhancing self-efficacy in mpox prevention by bolstering knowledge, perceived risk awareness, and risk perception. Such initiatives are particularly crucial for middle-aged and older individuals to counteract the age-related decline in self-efficacy. Strengthening self-efficacy through these efforts is essential for fostering sustained preventive behaviors and promoting mental well-being. Ultimately, these interventions can contribute meaningfully to reducing mpox transmission and improving the overall health of the MSM community.