Cues to action, perceived risk, perceived benefits, perceived obstacles and executed safety behavior of preventing monkeypox infection among PLWH : a structural equation model

Abstract Background Between June and August, there was an increase in monkeypox cases in China, and the mortality rate (7%) caused by monkeypox infection among people living with HIV(PLWH) is higher than that of the general population. It is particularly important for PLWH to adopt healthy behaviors to prevent monkeypox infection. Health education activities to prevent infection have been carried out through various channels, but we know very little about the prevention and control behaviors adopted by PLWH. Methods The subjects of this cross-sectional study included 467 PLWHs from Heilongjiang Province, China. The questionnaire was collected through Questionnaire Star from August 11 to September 10, 2023, including general sociological data, cues to action(CA), perceived risk (PR), perceived benefits(PB), perceived obstacles(PO) and executed safety behavior(ESB) data. The effects of CA on PR, PB, PO, and ESB were calculated using a structural equation model, as well as the effects of PR, PB, and PO on ESB. We also calculated the intermediate effects of PR, PB, and PO between CA and ESB. Results There were statistically significant differences (P < 0.05) in gender, marital status, sexual orientation, fixed sexual partner, receiving HIV related treatment, heard of monkeypox, more accurate channels for obtaining information, more willing to access information channels, the most satisfactory channel for obtaining information and monkeypox cognition. There weren’t statistically significant differences (P > 0.05) in education level and occupation. The structural equation indicates that cues to action(CA) was predictive factors for perceived risk (PR), perceived benefits(PB), perceived obstacles(PO) and executed safety behavior(ESB) (P < 0.001). Perceived risk (PR), perceived benefits(PB) and perceived obstacles(PO) were predictive factors for the executed safety behavior(ESB) (P < 0.01). PR played a mediating role of 33.99% between CA and ESB. PO played a mediating role of 6.9% between CA and ESB. PB didn’t play a mediating role between CA and ESB. Conclusions This study indicates that preventing monkeypox behaviors among PLWH is better, but there is still a gap between correctly implementing preventive behavior by everyone. CA, PR, PB, and PO are predictive factors for ESB. PR and PO play a mediating role between CA and ESB. Therefore, increasing CA, PR, and PB, and reducing PO can be used to improve the ESB of monkeypox among PLWH.