Interpersonal Level Factors Research Articles

Factors Influencing Depression in People with Disabilities:Individual and Interpersonal Levels

Abstract Depression is an increasingly important social problem, and this also applies to the disabled, a health-vulnerable group. Although the distribution and influencing factors of depression may be different among the disabled population (young adults vs. the elderly, older adults with disabilities vs. disabilities due to old age), only the high prevalence of depression among the disabled is generally reported. This study seeks to determine the distribution and influencing factors of depression in disabled people according to sociodemographic standards. This study employed data from the 2021 Panel Survey on People with Disabilities (National Unit Survey) to investigate the influence of individual-level factors (health behaviors, health level, environment) and interpersonal-level factors (social network) on depression. Multivariate logistic regression analysis was performed while controlling for demographic sociological factors and disability characteristic factors. The experience of depression was among elderly disabled individuals (age 50+: 40.9%) than younger ones (age 19-49: 36.1%), and in disability with aging (49.3%) versus aging with disabilities (39.2%) (P < 0.05). Chronic diseases, daily living assistance, living environment, and emotional support from family and neighbors affected both young and elderly disabled individuals. Specifically, among the elderly disabled, exercise frequency (aOR=0.78; [CI]0.63-0.97), social network size (aOR=0.87; [CI]0.82-0.93), and social interaction frequency (aOR=0.68; [CI]0.51-0.91) were significant. Disability with aging was influenced by exercise frequency (aOR=0.29; [CI]0.09-0.95) and emotional support (aOR=0.37; [CI]0.17-0.77) from peers. older adults with disabilities were affected by not only individual-level factors (exercise frequency) but also both functional (emotional support) and structural (size of social network, frequency of meetings) aspects of their interpersonal social networks. Key messages • Depression experiences among older adults with disabilities are influenced by both functional and structural social networks. • Developing depression prevention strategies for people with disabilities requires a customized approach that takes into account age-specific characteristics.

Factors associated with clinical nurse’s mental health: a qualitative study applying the social ecological model

BackgroundThe prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions.MethodsThis was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed.ResultsFour major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy.ConclusionsOur study provides a nuanced understanding of the multifaceted factors influencing nurses’ mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings.Trial and protocol registrationThe larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676.Reporting methodThis study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Using an ecological model of health behaviour to identify factors associated with smoking behaviour among Buddhist novices in Thailand: a cross-sectional digital survey

ObjectiveBuddhist novices reside in Buddhist temples, which are legally designated as smoke-free areas. Nevertheless, similar to other men in their age group, they are susceptible to various risk factors that...

Sexual Identity Development and Social Ecological Facilitators and Barriers of PrEP Uptake and Adherence Among Latinx Men Who Have Sex with Men.

Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.

Long-term care planning and the influencing factors among sexual minority older women: A qualitative study.

The aim of the study was to explore plans, considerations and factors influencing long-term care among older sexual minority (SM) women. Qualitative interview study. Semi-structured in-depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio-ecological model and constant comparative analysis. The most frequently reported long-term care plans were housing and institutions, private medical or long-term care insurance, financial planning and medical decisions. Factors associated with women's long-term care plans were categorized using the socio-ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal-level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community-level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal-level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources. This study identified multi-level factors related to long-term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long-term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women. This study assists nurses in understanding older SM women's long-term care concerns and worries when accessing long-term care and healthcare services and helps nurses provide SM-sensitive services and care for women. SM older women were recruited from LGBT organizations, LGBT-friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling.

Factors Associated With Participation in Physical Leisure Activities in Taiwanese Community-Dwelling Older Adults.

This study was to identify factors at the intrapersonal, interpersonal, and community levels that relate to physical leisure participation in Taiwanese community-dwelling older adults and to examine their relative importance. We used a cross-sectional study with purposive sampling (N = 160). Physical leisure participation was quantified as the variety, frequency, and duration of participation. Data were analyzed using a series of hierarchical multiple linear regressions. The results showed that higher variety, frequency, or duration of physical leisure participation was associated with older males and with those who reported having better health, fewer depressive symptoms, and greater social support. Intrapersonal- and interpersonal-level factors play a relatively more important role in predicting physical leisure participation than factors at the community level. Understanding factors that relate to these three levels of participation has the potential to inform interventions that are tailored to individual profiles.

Workplace inclusion: A scoping review of the qualitative literature.

An inclusive workplace culture supports and values the individual and collective work processes of workers from diverse backgrounds. The reality or perception of inclusion or exclusion at work can influence the social functioning, health, and well-being of workers. However, we lack knowledge about the concepts relevant to inclusion at the workplace. Furthermore, research is needed to better understand the drivers and obstacles to workplace inclusion to better promote participation in working life. This scoping review of the qualitative literature identifies the barriers to and facilitators of workplace inclusion. Systematic searches of five databases were conducted from 2000 to January 2020. Pairs of reviewers independently screened and reviewed all citations and full-text articles. We used Arksey and O'Malley's scoping review framework which advances through five stages. Barriers and facilitators of workplace inclusion were categorized relative to a multi-layered conceptualization of workplace inclusion and grouped by theme. Studies were described and thematic results totaled and communicated with evidence tables and conceptual maps. Thirty-nine qualitative studies met our inclusion criteria. All five domains of the multi-layered framework were represented by the reported shared experiences of study participants. Organizational level factors, especially attitudinal barriers were the most reported barriers to workplace inclusion. Facilitators of workplace inclusion focused on employer level factors and most often cited the role of inclusive leadership and support. Workplace inclusion requires consideration of societal, organizational, employer, and interpersonal level factors in addition to individual worker characteristics.

Low Behavioral Intention to Use Any Type of HIV Testing and HIV Self-Testing among Migrant Male Factory Workers Who Are at High Risk of HIV Infection in China: A Secondary Data Analysis

This study investigated the prevalence of and factors associated with behavioral intention to take up any type of HIV testing and HIV self-testing (HIVST) in the next six months among male migrant workers, who were at high risk of HIV infection, in Shenzhen, China. This was a secondary data analysis. A total of 363 subjects who had sexual intercourse with non-regular female sex partners and/or female sex workers in the past six months were selected. Logistic regression models were fitted for data analysis. About 16.5% of participants reported having used HIV testing in their lifetime and 12.7% for HIVST. Among the participants, 25.6% and 23.7% intended to take up any type of HIV testing and HIVST in the next six months, respectively. Significant factors associated with the behavioral intention to take up HIV testing and HIVST included individual-level factors based of the Health Belief Model (e.g., perceived benefit, perceived cue to action, perceived self-efficacy) and interpersonal-level factors (e.g., frequency of exposure to health-related content or HIV and STI-related content on short video apps). This study provided practical implications for designing interventions to increase the uptake of HIV testing and HIVST among migrant workers.

Socio-economic factors associated with mental health outcomes during the COVID-19 pandemic in South Korea.

Individuals are at an increased risk of adverse mental health outcomes during the COVID-19 pandemic. To reduce the impact on mental health outcomes that were induced by national-level policies, which may influence an individual at the community level, exploring the comprehensive relations between individual and environmental factors are needed. The aim is to examine socio-ecological factors associated with mental health outcomes, including depressive and anxiety symptoms, with the perspective of support to provide interventions that help the community during future disease outbreaks. From 5 November to 20 November 2020, a cross-sectional and population-based study was conducted to assess the socio-ecological factors of mental health outcomes during the COVID-19 pandemic. A total of 1,000 participants, aged 20-69 years, in Chungnam Region, South Korea, were included in this study. Multiple linear regression models were used to examine the association between socio-ecological factors and mental health outcomes. The primary outcomes were individuals' mental health outcomes which are measured by PHQ-9 and GAD-7 scores. Of the 1,000 participants, the average PHQ-9 was 4.39, and GAD-7 was 3.21 during the COVID-19 pandemic. Specifically, the participants with moderate or severe levels of PHQ-9 and GAD-7 were 12.6 and 6.8%, respectively. Higher levels of depressive and anxiety symptoms were associated with participants who were single, reported a lower household income, had decreased support from friends or family, and increased stress from the workplace or home. In subgroup analyses by age, gender, and household income, a similar trend was reported in individual and interpersonal-level factors. There were significant associations between regional-level factors, including gross regional domestic product (GRDP), mental health institutions, psychiatrists, nurse-to-population ratios, and individuals' mental health outcomes. The management of depressive and anxiety symptoms of individuals during the pandemic was better explained by individual and interpersonal characteristics rather than regional-level factors, highlighting the need for more policies aimed at these lower levels.

Factors Associated With E-Cigarette Quitting Behavior Among Adolescents in the United States: A Prospective Observational Study

PurposeThis prospective observational study examined the association of socioecological factors with quitting behavior among US adolescents who exclusively use electronic cigarettes (e-cigarettes). MethodsWe used data from past 30-day adolescent exclusive e-cigarette users (n = 243) participating in Wave 3 of the Population Assessment of Tobacco and Health study, who were then followed-up with approximately 12 months later for Wave 4. Weighted unadjusted and adjusted multivariate logistic regression models and structural equation modeling were performed to analyze the data. ResultsAdolescents were significantly less likely to quit e-cigarettes if they perceived that nicotine in e-cigarettes was “slightly/somewhat harmful” to health (adjusted odds ratio [aOR] = 0.38; 95% confidence interval [CI]: 0.16–0.90, p = .02). Similarly, adolescents who reported that someone else in their home owned an e-cigarette (aOR = 0.43 [95% CI: 0.19–0.94], p = .03) or important people in their life used e-cigarettes (aOR = 0.45 [95% CI: 0.21–0.95], p = .03) were significantly less likely to quit e-cigarettes. The structural equation modeling showed a direct significant relationship of individual-level (b = 0.206, p = .02) and interpersonal-level factors (b = 0.170, p = .04) with e-cigarette quitting behavior. DiscussionOur findings suggest that individual-level (harm perception) and interpersonal-level (e-cigarette use at home and by important people) factors may play a significant role in e-cigarette quitting behavior among US adolescents.

Follow-Up to High-Resolution Anoscopy After Abnormal Anal Cytology in People Living with HIV.

Current expert recommendations suggest anal cytology followed by high-resolution anoscopy (HRA) for biopsy and histological confirmation may be beneficial in cancer prevention, especially in people living with HIV (PLWH). Guided by the social ecological model, the purpose of this study was to examine sociodemographic and clinical variables, individual-level factors (depression, HIV/AIDS-related stigma, and health beliefs) and interpersonal-level factors (social support) related to time to HRA follow-up after abnormal anal cytology. We enrolled 150 PLWH from a large HIV community clinic, with on-site HRA availability, in Atlanta, GA. The median age was 46 years (interquartile range of 37-52), 78.5% identified as African American/Black, and 88.6% identified as born male. The average length of follow-up to HRA after abnormal anal cytology was 380.6 days (standard deviation = 317.23). Only 24.3% (n = 39) of the sample had an HRA within 6 months after an abnormal anal cytology, whereas 57% of the sample had an HRA within 12 months. HIV/AIDS-related stigma [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.33-0.90] and health motivation (OR 0.80, 95% CI 0.67-0.95) were associated with time to HRA follow-up ≤6 months. For HRA follow-up ≤12 months, we found anal cytology [high-grade squamous intraepithelial lesions/atypical squamous cells of undetermined significance cannot exclude HSIL (HSIL/ASCUS-H) vs. low-grade squamous intraepithelial lesions (LSIL) OR = 0.05, 95% CI 0.00-0.70; atypical squamous cells of undetermined significance (ASCUS) vs. LSIL OR = 0.12, 95% CI 0.02-0.64] and health motivation (OR = 0.86, 95% CI 0.65-0.99) were associated. Findings from this study can inform strategies to improve follow-up care after abnormal anal cytology at an individual and interpersonal level in efforts to decrease anal cancer morbidity and mortality.

Behavioral Intention to Get a Booster Dose of COVID-19 Vaccine among Chinese Factory Workers.

China started to offer a booster dose of COVID-19 vaccine to members of the adult population in October 2021. This study investigated the behavioral intention to receive a booster dose of COVID-19 vaccine among factory workers who had completed their primary vaccination series. Participants were full-time factory employees at least 18 years of age in Shenzhen, China. In Shenzhen, factory workers need to receive a physical examination every year. The study sites covered all six organizations providing physical examinations for factory workers. All eligible workers attending these sites between 26 and 31 October 2021 were invited to complete an online survey. This study was based on 2329 participants who had completed the primary COVID-19 vaccination series. Two-level logistic regression models were fitted. Among the participants, 84% intended to receive a free booster dose of COVID-19 vaccine within the next six months. After controlling for significant background characteristics, we found that perceptions related to a booster dose as well as interpersonal level factors such as information exposure on social media, thoughtful consideration of the veracity of the information, and satisfaction with vaccine-related promotional materials were determinants of behavioral intention. Factory workers in China reported a high level of behavioral intention to receive a booster dose of the COVID-19 vaccine.

A Socioecological Perspective of How Physical Activity and Sedentary Behaviour at Home Changed during the First Lockdown of COVID-19 Restrictions: The HomeSPACE Project.

The COVID-19 pandemic forced school closures, resulting in home schooling, more time spent at home and fewer opportunities for physical activity (PA). This study explored factors influencing PA and sedentary behaviours (SB) within the home environment during the first lockdown, starting in March 2020. Twenty semi-structured interviews (20 parents and 23 children, 12 years ± 1.25) were conducted. Data were coded using thematic analysis on NVivo© and concepts from McLeroy’s socioecological model for health promotion were used to analyse the data. Findings indicate that children’s PA and SB at home were influenced by: (i) individual-level factors (e.g., gender, competence, attitudes and motivation); (ii) interpersonal-level factors (e.g., siblings, parents, pets, friends and coaches); (iii) organisation-level factors (e.g., school, clubs and societies), (iv) community-level factors (e.g., home and local environment, access to facilities, social norms, time constraints and home equipment), and (v) policy-level factors (e.g., lockdown restrictions). Stay-at-home mandates resulted in perceived reductions in PA and increases in SB within the home; however, this provided alternative positive opportunities for families, including more time to spend together and exploring green and blue spaces in the local area.

Self-Reported Compliance with Personal Preventive Measures among Office Workers After Work Resumption during the COVID-19 Outbreak in Pakistan.

ABSTRACT.As the lockdowns have been lifted to relieve pressure on the economy, strict adherence to personal preventive measures (PPMs) in offices is essential to control the COVID-19 pandemic. This study investigated self-reported compliance with three PPMs among a sample of office workers in Karachi, Pakistan. A cross-sectional survey with participants were adult office workers who had resumed work in Karachi, Pakistan. All full-time employees aged ≥ 18 years who had resumed work in the offices were invited to complete the survey. Of 487 workers who were invited, 411 (84.4%) completed the survey between March 1 and March 20, 2021. We examined the effects of sociodemographic factors, individual-level factors, interpersonal-level factors, and social-structural–level factors using logistic regression models. Of the total sample, 192 (46.7%) reported always wearing a face mask in the workplace. Self-reported sanitizing of hands (46.0%) was comparable to use of face masks, whereas avoiding crowded places (21.2%) was less common. Perceived effectiveness of individual preventive measures (adjusted odds ratios [AORs] from 1.19 to 1.42; confidence intervals (CIs) 1.04–1.37 to CI 1.18–1.71), perceived effectiveness of governmental preventive measures (AORs from 1.23 to 1.39 CI 1.02–1.47 to CI 1.12–1.72), and number of preventive measures implemented by the office (AORs from 1.20 to 1.26 CI 1.09–1.31 to CI 1.13–1.39) were associated with self-reported compliance with PPMs. Perceived preparedness of medical system in Karachi (AOR 1.44, CI 1.08–1.93) was only associated with self-reported sanitizing of hands. Reduced compliance to PPMs was observed; hence, efforts need to be made to ensure strict adherence to PPMs.

Teen dating violence: From analyzing the problem to finding solutions.

Teen dating violence: From analyzing the problem to finding solutions.

Using the Socio-ecological Model to Explore Facilitators and Deterrents of Tobacco Use Among Airmen in Technical Training.

Military personnel have some of the highest rates of tobacco use in the USA. Within the Air Force, a common point of Airmen's (re-)initiation of tobacco use is during technical training once the tobacco ban has been lifted. Unfortunately, little is known about what factors facilitate and deter tobacco use during technical training. The socio-ecological model, which emphasizes multiple levels of influence on behavior (e.g., personal, intrapersonal, and environmental), provides a strong and comprehensive basis for which to explore factors that may impact tobacco use during technical training. Twenty-two focus groups were conducted among Airmen (n = 10), Military Training Leaders (MTLs, n = 7), and Technical Training Instructors (TTIs, n = 5). Semi-structured focus group protocols were developed based on the socio-ecological model and included questions intended to elicit factors that facilitated and deterred tobacco use during technical training. Focus groups were transcribed and then coded using a hybrid deductive-inductive process. At the personal level, five factors were identified that influenced tobacco use: choice, fit with lifestyle, associations with the tobacco experience, association with military job outcomes, and association with health outcomes. Three interpersonal level factors were identified: peer influence, leadership influence, and normative beliefs. There were two influential environmental level factors: pricing and promotion and access to tobacco. Except for normative beliefs, all personal, interpersonal, and environmental-level factors were discussed as having aspects that could either facilitate or deter tobacco use. Normative beliefs, an interpersonal-level factor, were only discussed as a facilitator of tobacco use. Taken together, study findings can be used to enhance the effectiveness of tobacco prevention and cessation programs for Air Force Technical Trainees. Specific strategies to support the reduction of tobacco use among Airmen are presented.

Relationship Factors Associated With Early Adolescent Dating Violence Victimization and Perpetration Among Latinx Youth in an Agricultural Community.

Latinx early adolescents within the United States are particularly vulnerable to dating violence; yet, little research has examined early dating experiences and violence outside large urban settings. Latinxs, in particular, may experience a unique window of opportunity for dating violence (DV) prevention during early adolescence, based on their trends in risk behavior over the adolescent period. This study extends the current research on dating violence by examining a highly understudied population, Latinx early adolescent girls and boys residing in an agricultural community, by assessing victimization and perpetration, and examining interpersonal-level factors as potential risk and protective factors for violence. Using data from a prospective cohort study of Latinx adolescents with relationship experience (past six months) (N = 296; girls: n = 147; boys: n = 149; mean age: 13.8), we assessed the association between dating relationship characteristics and dating violence victimization and perpetration using modified-Poisson regression models with robust standard errors stratified by gender. In multivariable analyses, we found that girls with gang-affiliated partners, partner-related withdrawal from friends, and girls who had used drugs or alcohol with a partner experienced greater risk for dating violence. Additionally, holding beliefs supportive of female sexual naivete and engaging in and communicating about sexual activity were associated with victimization among girls. No significant associations were found among boys. Findings affirm the need for multilevel DV prevention programming that starts in middle school and addresses social isolation, gang exposure, and traditional Latinx gender-norm beliefs regarding marianismo. These findings underscore the imperative to coordinate dating and gang violence prevention efforts by addressing common co-occurring interpersonal and environmental risk factors, including social isolation and culturally-specific traditional beliefs. Such factors could also assist providers, families, and peers in early identification of Latinx early adolescents at risk for DV, especially in rural contexts where resources are often limited.

Impact of Organisational, Personal and Interpersonal Factors on Employee Performance in Small and Medium Size Enterprises

The purpose of this study is to examine the impact of organisational level factors (management support, dynamic environment and organisational culture), personal level factors (personal effectiveness, locus of control) and interpersonal level factors (transactional styles and conflict management styles) on employee performance. The study also examines the interrelation between organisational, personal and interpersonal factors.In this study, organisational, personal and interpersonal level factors are included in a single model using data from small- and medium-scale enterprises. The structural equation modelling is used to examine the proposed model describing the relationship between employee performance and three-level factors.The results of this study indicate that management support and personal effectiveness have the strongest impacts (direct and indirect) on employee performance, while locus of control and transactional styles directly affect job performance. Overall 29% (first-level analysis) and 38% (second-level analysis) of employee performance (EP) variance can be explained.The findings of this study have implications for practitioners, academicians and policy makers for effective decision making as organisations are facing intense competition for survival and sustenance in the turbulent business environments. The employee performance is considered one of the important factors and there is a need to identify the factors affecting the performance of employees.

Experienced barriers to adherence to pre-exposure prophylaxis for HIV prevention among MSM: a systematic review and meta-ethnography of qualitative studies

ABSTRACT Men who have sex with men (MSM) in the United States are at disproportionate risk for HIV. Once-daily pre-exposure prophylaxis (PrEP) for HIV prevention is a highly effective method of preventing HIV infection; however, optimal adherence is necessary to maintain effectiveness. Many studies have profiled perceived barriers to adherence among at-risk MSM; however, nearly a decade after FDA approval, there has been little work examining experienced barriers to adherence among MSM who have previously used the medication. To assess the current state of this literature and its implications for behavioral interventions, we conducted a meta-ethnography (i.e., A systematic review and synthesis of qualitative studies) of experiences with PrEP use among cis-gender MSM in the United States. We found that structural-level interventions, such as telehealth and pharmacist-prescribed approaches to PrEP distribution, may circumvent barriers to uptake and adherence for some MSM, but may not be enough for already underserved communities, such as MSM of color. Furthermore, interpersonal-level factors, such as enacted PrEP stigma by providers and peers, highlight the necessary consideration of social identity in the branding of PrEP for HIV prevention. Tailored interventions should consider experienced barriers to PrEP adherence across socioecological levels to be most effective.

‘I married when I was 16… due to poverty, I had no other way’: multi-level factors influencing HIV-related sexual risk behaviours among adolescent girls in Zambézia, Mozambique

This paper explores individual, interpersonal- and household-level factors influencing HIV-related sexual risk behaviour among adolescent girls who participated in an intervention to reduce HIV risk in a rural setting in Mozambique. Twenty-eight adolescent girls ages 13–19, 30 heads of household, and 53 influential men participated in in-depth interviews at two time points. Comparative analysis compared girls who reported reducing risk behaviours over time to girls who did not and identified factors that respondents described as influential to behaviour change. Among the twenty girls self-reporting sexual risk at the first time point, half had reduced these behaviours one year later. Changes in girls’ behaviours were contingent upon household- and interpersonal-level factors, particularly households’ economic stability and family members’ financial support. Future interventions with adolescents in similar settings should evaluate and leverage household and family support to achieve sexual risk reduction.